Open excision of a subcutaneous soft-tissue tumor or vascular malformation from the hand or finger, with the resected specimen measuring 1.5 cm or greater.

Verified May 8, 2026 · 5 sources ↓

Medicare: $393.13
Work RVU: 5.28
Global, days: 90
Region: Hand

Drawn from CMSAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Lesion size documented in centimeters in the operative report — specimen measurement, not incision length
Anatomic location specified (which digit or area of hand, left vs. right)
Lesion type identified (subcutaneous tumor or vascular malformation, not a skin lesion addressed by integumentary codes)
Preoperative imaging or clinical workup supporting the diagnosis and surgical necessity
Pathology report or order confirming specimen was sent for histologic evaluation
Operative note describes dissection depth confirming subcutaneous (not deeper tendon/bone) plane of excision

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26111 covers open surgical removal of a subcutaneous tumor or vascular malformation located in the soft tissue of the hand or finger when the lesion is 1.5 cm or larger. This distinguishes it from CPT 26110, which applies to lesions under 1.5 cm. The size threshold refers to the excised specimen, not the skin incision, so operative documentation must state the lesion dimensions explicitly.

The 90-day global period means all routine follow-up — wound checks, suture removal, dressing changes — is bundled through day 90. Any E/M visit in that window for an unrelated condition requires modifier 24; a same-day E/M for a separately identifiable problem needs modifier 25 appended to the E/M, not to 26111.

Site of service matters significantly here. HOPD and ASC payments differ substantially — see the site-of-service comparison table on this page. When the same surgeon performs multiple lesion excisions on the same hand at the same session, apply modifier 51 to the lower-valued code(s). Pathology (CPT 88302–88309) is separately reportable and should always be ordered to support the diagnosis code and rule out malignancy.

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 (5.28) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.77) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.28
Practice expense RVU	5.45
Malpractice RVU	1.04
Total RVU	11.77
Medicare national rate	$393.13
Global period	90 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	$393.13
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 26111 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Lesion size not documented or recorded as under 1.5 cm, triggering downcode to CPT 26110
Code billed for a skin lesion that should have been reported under integumentary excision codes (11400–11446)
Missing or mismatched ICD-10 diagnosis — benign neoplasm vs. vascular malformation codes must align with operative findings
Bilateral procedure billed without LT/RT modifiers or modifier 50, causing MUE flag
E/M service billed same-day without modifier 25, bundled into the global by payer

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 26110 and CPT 26111?

Size threshold. CPT 26110 covers subcutaneous lesion excisions under 1.5 cm; 26111 applies when the excised specimen is 1.5 cm or greater. Measure the specimen, not the skin incision, and document that measurement by name in the operative report.

02Can I bill 26111 for a skin lesion on the hand?

No. CPT 26111 is for subcutaneous tumors and vascular malformations — the lesion must originate below the dermis. Epidermal or dermal lesions belong in the integumentary excision series (11400–11446). Billing 26111 for a surface lesion is a common audit target.

03If I excise two separate lesions on the same hand during one session, how do I bill?

Bill 26111 for the primary lesion and apply modifier 51 to the secondary excision code. If the second lesion is under 1.5 cm, that line would be 26110-51. Document each lesion's size and location separately in the operative note.

04Does the 90-day global period affect billing for a post-op complication that requires a return to the OR?

A return to the OR for a complication related to the original excision uses modifier 78. An unrelated procedure during the global period uses modifier 79. Do not invert these — modifier 78 is specifically for unplanned returns tied to the original procedure.

05Should I separately report pathology after excising a subcutaneous hand tumor?

Yes. Surgical pathology (CPT 88302–88309, depending on complexity) is always separately reportable and not bundled into 26111. Always send the specimen and document the order — pathology results also substantiate the diagnosis code and support medical necessity if the lesion proves benign.

06Is modifier 50 appropriate for bilateral hand lesion excisions on the same date?

For physician claims, bill one line with modifier 50. For ASC facility claims, CMS requires two separate lines with modifier LT on one and RT on the other, each with one unit of service. Confirm your payer's preference, as some commercial payers follow ASC convention even for physician billing.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures lesion size in centimeters from dictation, left/right laterality, anatomic location within the hand or finger, and the subcutaneous dissection plane — the four elements auditors most commonly flag as missing. That prevents downcoding to 26110 and blocks claim rejections tied to unspecified laterality or misrouted integumentary codes.

See how Mira captures CPT 26111 documentation