CPT Code 11400 to 11446: Excision of Sebaceous Cyst Reimbursement

CPT codes ranging from 11400 to 11446 are used to bill excision of sebaceous cyst. But the question is when to bill CPT 11400, 11402, 11403, 11404 or any other CPT code for excision of sebaceous cyst?

Nothing to worry because I have got you covered but before moving to that, we should know what is excision and sebaceous cysts and what specialty providers can perform and bill these procedure codes. Keep reading to know everything about sebaceous cyst removal reimbursement.

Excision of Sebaceous Cyst Reimbursement CPT Codes

CPT Code 11400 To 11446 - Excision Of Sebaceous Cyst Reimbursement
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What is Excision?

The procedure of “Excision” refers to when some sharp instrument is used to cut out or off a portion of a body part without replacement of the part.

What is Sebaceous cyst?

These are non-cancerous and benign growth beneath the surface of the skin consisting of sacs that are filled with oily material. They are often also referred to be epidermal inclusion cysts.

Excision of Sebaceous Cysts

Excision of sebaceous is hence defined as full-thickness removal of a lesion involving margins and also covers simple (non-layered) closure.

Make sure to timely submit the claim to the insurance company to avoid CO 29 denial

Sebaceous Cyst Removal Coding and Billing Guidelines

Excision of benign lesions which are of cutaneous origins, such as a sebaceous cyst, should be reported using CPT codes 11400–11446.

Excision of benign lesions requiring intermediate or complex closure, report 11400-11446 in addition to appropriate intermediate (12031-12057) or complex closure (13100-13153) codes. Repair by intermediate (layer) closure, complex repair, skin graft, or pedicle flap wound is reported separately.

After properly coding the claim, you will need to submit the claim to insurance through paper or electronically. For electronic submission, use our payer id lookup tool to make sure you’re submitting claim at correct payer ID.

CPT codes 11400 – 11446 description and selection

CPT code selection from 11400 – 11446 depends on the diameter of the greatest clinical diameter of the apparent lesion plus the margin required for complete excision.

For better understanding, below I have mentioned the descriptions of most frequently used CPT codes from 11400 to 11446.

11400 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

11401 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm

11402 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm

11403 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm

11404 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm

11406 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm

11420 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11421 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

11422 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm

11423 CPT Code

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm

11440 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less

11441 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm

11442 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm

11443 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm

11444 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm

11446 CPT Code

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm

Read a detailed guide about PR 1 denial code or go through the complete list of claim adjustment reason codes

Sebaceous Cyst Removal Procedure

The area is cleansed and a local anesthetic is injected. A narrow margin of healthy tissue is identified and a full-thickness incision is made through the dermis. The incision is carried around the lesion and the entire lesion is excised.

The lesion is sent to the laboratory for separately reportable histologic evaluation. Bleeding is controlled by electrocautery or chemical cautery. The wound may be closed using a simple single-layer suture technique.

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Sebaceous Cyst Excision Documentation

The size of the lesion excised in centimeters (more preferably), must be documented in the chart to correctly assign the code.

Sebaceous Cyst Removal Reporting Limitations

Excision of benign lesions with an excised diameter of 0.5cm or less includes simple, intermediate, or complex repairs which should not be reported separately.

Medicare Coverage Indications for Sebaceous Cyst Removal

Medicare has a strict policy limited to certain conditions for reimbursement of such procedures

  1. Those benign skin lesions which do not pose a threat to the health or function and are considered cosmetic are not covered by Medicare
  2. If one or more of the following conditions are presented and clearly documented in the medical record:
  • Intense itching
  • Pain
  • Bleeding
  • Change in physical appearance (reddening or pigmentary change)
  • Recent enlargement
  • Increase in the number of lesions
  • Physical evidence of inflammation or infection, e.g., purulence, oozing, edema, erythema, etc.
  • Lesion obstructs an orifice
  • Lesion clinically restricts eye function

Coverage limitations

If the patient intends to remove the benign asymptomatic lesions for cosmetic purposes, he/she will become liable for the service rendered. The physician has the ultimate responsibility to notify the patient in advance about it and the patient is responsible for the cost of the services. Charges should be clearly stated and it is strongly advised that the beneficiary, by his or her signature, accept responsibility for payment.

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CPT Code 11400 to 11446 Global Period

The global period for excision of sebaceous cyst CPT codes is 10 days.

E/M service and surgical procedure

Medicare will not pay for a separate E & M service;

  • On the same day as a minor procedure
  • During the global period of the minor surgery

The only case when the E/M will be allowed is when there is significant and separately identifiable medical service (unrelated medical condition to the surgical procedure) clearly and fully documented in the patient’s medical record and a modifier 25 should be used with E/M in that case.

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