Excision of a benign skin lesion on the trunk, arm, or leg when the total excised diameter, including margins, is more than 4.0 cm.
- Medicare
- $333.67
- Work RVU
- 3.43
- Global, days
- 10
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Lesion diameter plus margins measured before excision
- Location on trunk, arm, or leg
- Depth of excision
- Closure type and length
- Pathology sent and final diagnosis
- Reason for removal (symptoms, suspicion, function)
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
11406 is the largest size in the benign skin lesion excision codes for the trunk, arms, and legs. The size is the lesion's greatest diameter plus the narrowest margin on each side, measured before excision. It has a 10-day global.
Orthopedic surgeons sometimes excise large benign skin lesions on the limbs, such as a big epidermal inclusion cyst on the thigh. Lipomas are a common trap. A lipoma under the skin is a soft tissue tumor, and the soft tissue tumor excision codes in the musculoskeletal section, chosen by site and depth, are usually the right choice. The 11400 series is for lesions of the skin itself.
Simple closure is included in 11406. Intermediate or complex repair is billed separately when documented, using the 12031 series or the complex repair code for the site. Pathology results drive the code family: if the lesion turns out malignant, the malignant excision codes apply. Measure and write the size before the incision, because pathology measurements after excision shrink.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (3.43) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.99) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.43 |
| Practice expense RVU | 5.92 |
| Malpractice RVU | 0.64 |
| Total RVU | 9.99 |
| Medicare national rate | $333.67 |
| Global period | 10 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $333.67 |
HOPD (APC 5072) Hospital outpatient department | $1,687.37 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $742.04 |
Common denial reasons
The recurring reasons claims for CPT 11406 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Size taken from pathology report instead of pre-excision measurement
- Lipoma coded as skin lesion instead of soft tissue tumor
- Malignant pathology coded as benign excision
- Cosmetic removal without medical necessity
- Layered closure billed without documentation
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How do I measure for 11406?
02Should a lipoma be coded with 11406?
03Is closure included in 11406?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the lesion size with margins before excision and the closure performed, so size-based coding holds up on audit.
See how Mira captures CPT 11406 documentation