Summary & Overview
CPT 11402: Excision of Benign Skin Lesion, 1.1-2.0 cm, Trunk, Arms, or Legs
CPT code 11402 is a widely used billing code for the excision of benign skin lesions, specifically those measuring 1.1 cm to 2.0 cm in diameter on the trunk, arms, or legs. This procedure is a routine surgical intervention performed by dermatology, surgery, and family medicine physicians to address non-cancerous skin growths. The code is relevant for office-based and ambulatory surgical center settings, reflecting its accessibility and frequency in outpatient care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for this service, underscoring its importance in both clinical practice and medical billing. The publication provides an overview of payer coverage, clinical context, and policy updates related to 11402. Readers will gain insight into coding benchmarks, payer requirements, and the procedure's role in skin lesion management. The summary also highlights common modifiers and associated taxonomies, offering a comprehensive perspective for stakeholders involved in medical billing, compliance, and clinical operations.
This article serves as a resource for understanding the national landscape of 11402, including its clinical indications, typical sites of service, and payer coverage. It is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on this essential dermatologic procedure.
CPT Code Overview
CPT code 11402 describes the excision of a benign skin lesion, including margins, on the trunk, arms, or legs, with a lesion diameter between 1.1 cm and 2.0 cm. This procedure is performed to remove non-cancerous growths that may cause discomfort, cosmetic concerns, or diagnostic uncertainty. The service is typically provided in an office setting (Place of Service 11) or an ambulatory surgical center. As a surgical procedure on the skin, it is commonly performed by dermatology, surgery, or family medicine physicians.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology or family medicine clinic with a benign skin lesion located on the trunk, arm, or leg. The lesion measures between 1.1 cm and 2.0 cm in diameter. After clinical evaluation, the provider determines that excision is appropriate. The procedure is performed in an office or ambulatory surgical center setting. The provider excises the lesion, ensuring removal of the lesion and appropriate margins, and sends the specimen for pathology if indicated. The patient is monitored for wound healing and potential complications.
Coding Specifications
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Modifier
59: Distinct Procedural Service. Used when a procedure or service is distinct or independent from other services performed on the same day. -
Modifier
51: Multiple Procedures. Used when multiple procedures are performed during the same session by the same provider.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207N00000X | Dermatology Physician |
208600000X | Surgery Physician |
207Q00000X | Family Medicine Physician |
These taxonomies represent the specialties commonly performing excision of benign skin lesions.
Related Diagnoses
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D23.5: Other benign neoplasm of skin of trunk- Relevant for excision of benign lesions located on the trunk.
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D23.61: Other benign neoplasm of skin of right upper limb, including shoulder- Used when the excised lesion is on the right upper limb or shoulder.
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D23.62: Other benign neoplasm of skin of left upper limb, including shoulder- Used for lesions on the left upper limb or shoulder.
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D23.71: Other benign neoplasm of skin of right lower limb, including hip- Indicates excision of benign lesions on the right lower limb or hip.
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D23.72: Other benign neoplasm of skin of left lower limb, including hip- Used for excision of benign lesions on the left lower limb or hip.
Each diagnosis code corresponds to the anatomical location of the benign lesion being excised, supporting medical necessity for CPT code 11402.
Related CPT Codes
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11400: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia, or multiple areas; lesion diameter 0.5 cm or less. -
11401: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia, or multiple areas; lesion diameter 0.6 cm to 1.0 cm.
Both 11400 and 11401 are related to 11402 as they describe excision of benign lesions of different sizes and locations. These codes are alternatives based on lesion size and anatomical site. They may be used together if multiple lesions of varying sizes and locations are excised during the same session.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 11402 is $177.11, while the BUCA (average commercial) mean rate is higher at $182.92. Among individual commercial payers, UnitedHealth Group has the highest mean rate at $253.01, followed by Cigna at $233.12, Blue Cross Blue Shield at $174.50, and Aetna at $148.18.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $19.00, indicating relatively consistent rates nationally. In contrast, UnitedHealth Group exhibits the widest dispersion at $152.67, reflecting substantial variability in contracted rates. Cigna also has a wide range of $139.15, while Aetna and Blue Cross Blue Shield have moderate dispersions of $74.67 and $82.00, respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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