CPT Code 11406: Benign Lesion Excision Billing Guide (Trunk, Arms, Legs Over 4.0 cm)

CPT code 11406 reports full-thickness excision of a benign skin lesion on the trunk, arms, or legs when the excised diameter measures more than 4.0 cm. It is the largest size tier in the 11400 series and carries a 10-day global period.

The official description of CPT code 11406 is: excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm. The surgeon cuts through the full dermis. She removes the lesion with a rim of normal skin, then closes the wound.

Trunk covers chest, abdomen, back, flank, and buttock. Arms and legs cover the shoulder, upper arm, forearm, thigh, and lower leg. Hands, feet, scalp, neck, and genitalia route to 11420 through 11426 instead.

The margin is the ring of normal-looking skin taken around the visible lesion. CPT builds it into the code, so you count it in the size and never bill it separately. Simple closure is bundled too.

Where Does 11406 Fit in the Benign Lesion Excision Family?

Benign excision codes split first by anatomic site, then by excised diameter.

• How the 11420 and 11440 Site Families Differ: These families share the same six size breaks but pay more per tier. Facial and genital skin is thinner, so closure is harder. A 4.5 cm excision on the back is 11406. On the scalp, it is 11426.
• Why Site Selection Comes Before Size Selection: Size alone cannot pick the code. Read the note for the site, confirm which family owns that site, then apply the diameter.

How Do You Measure Excised Diameter Correctly?

Excised diameter equals the greatest clinical diameter of the lesion plus twice the narrowest surgical margin. Measure before you cut.

• The Lesion Diameter Plus Narrowest Margin Formula: Take the widest point of the lesion. Add the narrowest margin once for each side. A 3.4 cm lesion with 0.4 cm margins gives 4.2 cm, which crosses the threshold and lands on 11406.
• Why Measurement Must Happen Before Excision: Skin retracts the moment you release it, and formalin shrinks it further. A specimen measuring 4.2 cm on the patient can reach the lab at 3.6 cm. Sizing from pathology downcodes the claim.
• Measuring from the Specimen Versus the Patient: The pathologist measures what arrives in the jar. That number confirms what came out and whether margins are clear. It does not set the CPT tier.

Three errors repeat. Coders drop the margin, add it once instead of twice, or pull the number from pathology. Each error drops the claim one tier.

When Should You Report 11406 Instead of Another Removal Code?

Only one removal code applies per lesion. The documented method picks it.

• Excision Versus Shave Removal: Excision passes through the full dermis. Shave removal, codes 11300 through 11313, slices horizontally and stops short. If the note says “shaved” or “saucerized,” the 11400 series does not apply.
• Excision Versus Destruction Codes: Destruction uses heat, cold, chemicals, laser, or curettage, and leaves no intact specimen. Report 17110 or 17111 for benign destruction other than skin tags and vascular lesions.
• Benign Versus Malignant Lesion Excision: Pathology drives the family. A malignant result moves the claim to 11600 through 11606. Contractors state that a benign CPT code should not carry a malignant diagnosis code.
• Skin Tag Removal Exclusions: The descriptor excludes skin tags. Report 11200 for the first 15 lesions and 11201 for each additional group of 10, with one unit on 11200.

Is CPT Code 11406 Covered? Medical Necessity and Payer Policy

Coverage turns on whether the lesion threatens health or function. Cosmetic removal is a statutory exclusion under Social Security Act section 1862(a)(10) and 42 CFR 411.15(h).

Which ICD-10 Codes Support Medical Necessity for 11406?

Covered diagnosis lists live in the MAC billing article, not the LCD.

• Commonly Paired Benign Neoplasm Diagnoses: Common pairings are D22.- for moles and D23.- for other benign skin growths. Cysts take L72.0, L72.1, or L72.3. Use D48.5 when behavior is unclear.
• Symptom Codes That Strengthen the Claim: Some codes carry the symptom inside them. L82.0 describes inflamed seborrheic keratosis and L82.1 the uninflamed form. Choosing L82.0 when inflammation is documented tells the payer why removal happened.
• Diagnoses That Trigger Automatic Denial: Z41.1, encounter for cosmetic surgery, denies as a statutory exclusion, and contractors direct providers to append modifier GY with it. Malignant C43.- or C44.- codes on 11406 create a family mismatch.

What Does CPT 11406 Reimburse in 2026?

For 2026, Medicare’s national payment for CPT 11406 is $333.67 in a non-facility setting and $227.79 in a facility setting, before any locality-specific adjustment.

2026 RVUs and Medicare Payment

CPT 11406 has 3.43 work RVUs, 5.92 non-facility PE RVUs, 2.75 facility PE RVUs, and 0.64 malpractice RVUs, producing total RVUs of 9.99 non-facility and 6.82 facility. The sheet uses the $33.4009 non-QPP conversion factor.

Facility vs. Non-Facility

Medicare’s national payment is $333.67 non-facility versus $227.79 facility. The difference reflects the practice-expense components assigned to each setting.

Geographic Adjustment

Actual Medicare payment varies by locality because the RVU components are adjusted using the applicable GPCI values. The national amounts above are therefore benchmarks, not guaranteed local payments.

Private Payer Benchmarks

Reported private-payer benchmarks are $337.22 for BCBS, $390.36 for UHC, $414.57 for Aetna, and $390.99 for Cigna. These should be presented as payer-specific benchmarks rather than fixed national reimbursement rates.

QPP vs. Non-QPP

CPT 11406 is supported under the QPP and non-QPP rate options in the CMS MPFS Look-Up Tool. The supplied sheet is using the non-QPP rate, evidenced by its $33.4009 conversion factor. For QPP rates, the applicable conversion factor is $33.5675.

Which Modifiers Apply to CPT 11406?

Modifier choice depends on whether you are separating lesions, sequencing procedures, or entering a global period.

• Modifier 59 and X{EPSU} for Distinct Lesions: When two excisions on one date hit an NCCI edit, modifier 59 or the more specific XS separates them by anatomic structure. NCCI policy allows this only for different lesions or sites. Apply it to the second and later lines.
• Modifier 51 for Multiple Procedures: Modifier 51 flags multiple procedures at one session. Most Medicare contractors append it automatically and do not want it submitted. Commercial payers vary, so check each contract.
• Modifier 22 for Increased Procedural Service: Modifier 22 fits work that substantially exceeds the norm, such as dense scar from prior surgery. Attach a cover letter and the operative note, and expect manual review.
• Global Period Modifiers: 24, 25, 58, 78, and 79: Modifier 25 marks a significant, separately identifiable E/M. Modifier 24 marks an unrelated E/M within 10 days. Modifier 58 marks a staged procedure, 78 a return to the operating room for a complication, and 79 an unrelated procedure. Modifier 57 belongs to 90-day procedures and does not apply.

How Is Wound Closure Billed With 11406?

Simple closure is bundled. Intermediate and complex repair are separately reportable.

How Do You Bill Multiple Lesions Removed in One Session?

Each lesion gets its own line.

• Coding Each Lesion Separately by Site and Size: Treat every lesion as an independent procedure with its own site, measurement, and diagnosis link. One caution from NCCI policy: a single excision removing three nevi inside one ellipse is one code.
• Sequencing Lines From Highest to Lowest Value: Medicare pays the highest-valued procedure in full and reduces later surgical lines under the multiple procedure rule. List 11406 first when it is the largest excision on the claim.
• Why Diameters Cannot Be Added Together: Two 2.5 cm excisions are not one 5.0 cm excision. They are two procedures, coded 11403 and 11403. Adding diameters to reach 11406 is upcoding.

What Documentation Does 11406 Require?

The operative note must prove site, size, method, and medical reason without the reviewer guessing.

• Required Operative Note Elements: Record the site and side. Record the lesion diameter before cutting, the narrowest margin, and the total excised diameter. Add the depth reached, the closure type and length, and the clinical reason.
• Pathology and Specimen Submission Rules: The decision to send tissue is independent of the decision to remove it. When removal followed diagnostic uncertainty, the LCD expects a tissue diagnosis in the record. Multiple lesions sent as one specimen support one pathology code.
• Linking the Path Report Back to the Claim: Match the claim diagnosis to the pathology result. A benign result supports 11406, while a malignant result moves the claim to 11606 and changes the diagnosis family. Build a hold queue.

What Is the Global Period for 11406?

CPT Code 11406 carries a 010 global surgery indicator, covering the day of surgery plus the following 10 days.

• Included Post-Operative Services: Wound checks, suture removal, and dressing changes are included in the payment. So does care for routine complications and bleeding that avoids a return to the operating room.
• Billing E/M Visits During the Global Window: The decision to perform a minor procedure is not separately payable. Benign lesion removal is elective and pre-scheduled, so contractors call routine same-day E/M with modifier 25 inappropriate. Reserve it for a separate documented problem.

Why Do 11406 Claims Get Denied?

Final Words

CPT 11406 pays well when the note supports it and denies fast when it does not. The measurement sentence carries the claim. Record the lesion diameter, the narrowest margin, and the total before the blade touches skin. Then link that number to a covered diagnosis and a stated clinical reason. Re-verify RVUs, the conversion factor, and your MAC covered diagnosis list each January.