CPT Code 11404: Excision of benign lesion, trunk/arms/legs, 3.1-4.0 cm

Key takeaways

CPT Code 11404 covers excision of a benign lesion on the trunk, arms, or legs, excluding skin tags.

The excised diameter must measure 3.1 to 4.0 cm, counting the lesion plus the margin taken on each side.

The 2026 Medicare non-facility rate runs about $167 to $185, and the facility rate about $95 to $115.

Cosmetic removal is non-covered, so the ICD-10-CM code has to establish a clinical reason for the excision.

Practice management software like Pabau links procedure documentation directly to CPT code selection, cutting the tier errors behind many 11404 denials.

CPT Code 11404 covers excision of a benign skin lesion, including margins, on the trunk, arms, or legs. The excised diameter must measure 3.1 to 4.0 cm. That figure is the lesion plus the narrowest margin of normal tissue taken on each side. It decides which of the six 11400-series tiers applies.

Below you’ll find the official descriptor, 2026 Medicare rates, the RVU breakdown, modifiers, ICD-10-CM pairings, documentation requirements, and CCI bundling rules.

What CPT Code 11404 covers

In the code book the descriptor reads: excision, benign lesion including margins, except skin tag unless listed elsewhere, trunk, arms or legs. The size qualifier that makes it 11404 is an excised diameter of 3.1 to 4.0 cm.

The code sits in the Surgery section of the AMA’s CPT code set, under procedures on the integumentary system. Practices running skin clinic software with CPT workflows built in are less likely to pick the wrong tier at submission.

The physician removes the lesion together with a surrounding margin of normal tissue. Excision means a full-thickness removal through the dermis. A shave removal that stops short of that belongs in the 11300 series, where 11312 covers lesions of 0.6 to 1.0 cm.

How the 11400 series size tiers work

The 11400 series covers benign lesion excisions on the trunk, arms, and legs, with one code per diameter tier. Choosing the wrong tier is the leading cause of downcoding and upcoding denials in this family. It usually happens when the note records the lesion size and leaves the margin out.

Approximate rates only. Verify current figures using the CMS Physician Fee Schedule lookup tool, which reflects your locality’s GPCI adjustment.

The tiers either side of 11404 account for most misfiles. 11402 stops at 2.0 cm and 11406 starts above 4.0 cm, so a few millimeters of unrecorded margin can move the money.

Pathology can also move the claim into a different family. If the report comes back malignant, the excision belongs in the 11600 series instead. 11624 covers the same 3.1 to 4.0 cm range on the trunk, arms, and legs.

Anatomical site rules: trunk, arms, and legs

CPT codes 11400 through 11406 apply only to the trunk, arms, and legs. Lesions on the face, ears, eyelids, nose, lips, or mucous membranes go to the 11440 series, which starts at 11441. Getting the site wrong is a straightforward denial. The payer reads the operative note, sees a facial site, and rejects the claim.

Measuring excised diameter correctly

Excised diameter is not the lesion size alone. It equals the greatest dimension of the lesion plus the narrowest margin of normal tissue removed on each side. Closure size has no bearing on the code. Record the measured excised diameter in the operative note, not just “lesion excised” or “wound closed.”

Reimbursement and the 2026 fee schedule

Medicare pays differently by setting. Non-facility rates apply in a physician office, and facility rates apply in hospital outpatient departments and ambulatory surgical centers.

Both run through the Geographic Practice Cost Index, or GPCI, so a Manhattan practice sees different figures than one in rural Mississippi. Check your locality in the FastRVU 2026 RVU lookup, which uses current CMS fee schedule data.

RVU breakdown

Relative Value Units, or RVUs, drive the payment calculation. The total RVU for 11404 is multiplied by the annual CMS conversion factor and the applicable GPCI to produce your locality’s rate.

For CY2026, the conversion factor is $33.40 for clinicians outside a qualifying alternative payment model, and $33.57 for those inside one. Both figures come from the CY2026 Medicare Physician Fee Schedule final rule.

Source note: RVU figures are indicative, based on CMS fee schedule data. Confirm current values in the CMS Physician Fee Schedule lookup or the AAPC CPT code reference. RVUs change every year, so check them before your billing cycle turns over.

Modifiers for CPT Code 11404

Modifiers tell the payer that the circumstances justify a deviation from the standard payment rule. For 11404, the wrong modifier or a missing one is the second most common denial reason after tier selection.

Practice management software like Pabau lets billers attach modifiers at the point of claim creation, so nothing goes out missing one. The table below shows which modifiers come up with 11404 and when each applies.

CCI edits and bundling rules

Correct Coding Initiative edits, known as CCI edits, bundle certain codes together. The payer will not reimburse both separately unless a modifier justifies distinct billing. For 11404, the usual flashpoint is simple repair, starting at 12001.

When the closure is integral to the excision, the repair is bundled and cannot be billed on its own. A more complex, separately identifiable closure is different. Modifier 59, or the more specific XS modifier for a separate site, can override the edit. The operative note has to support that distinction.

Check the edit pairs quarterly, because CMS updates the tables four times a year.

ICD-10-CM codes that support medical necessity

The diagnosis code is what establishes medical necessity for the excision. Medicare and most commercial payers will not authorize payment without a supported ICD-10-CM code, and a cosmetic diagnosis does not qualify. Clinical documentation software that captures the indication in structured fields lets you pull that detail straight into the claim.

Always reach for the most specific code available. L98.9 is a last resort and attracts payer scrutiny. The D23 series, with its site-specific subcodes, is the most defensible pairing once pathology confirms a benign neoplasm.

Documentation requirements for CPT Code 11404

Missing or incomplete documentation is the main reason 11404 claims fail on audit. CMS and most Medicare Administrative Contractors, known as MACs, expect specific elements in the operative note.

Practices using digital forms can build those elements into a structured operative note template. Medical forms organized around the documentation rules hold up far better at audit than free-text notes.

• Lesion description: anatomical location, clinical appearance, size, and suspected diagnosis
• Measured excised diameter: the total in centimeters, lesion plus margins, not the lesion size on its own
• Indication for removal: the clinical reason, such as symptoms, concern for malignancy, or recurrent infection
• Operative technique: confirmation that the excision included margins of normal tissue
• Pathology report: CMS expects pathology for covered benign removals, so retain the report and link it to the claim
• Patient consent: documented informed consent for the procedure

Working to HIPAA-compliant documentation standards keeps operative notes and pathology reports stored securely and retrievable during a payer audit. Check your MAC’s Local Coverage Determination, or LCD, for extra requirements specific to your region.

Medicare coverage rules and medical necessity

Medicare covers benign lesion excision under 11404 once medical necessity is established. CMS article A57113 in the Medicare Coverage Database is the reference for covered and non-covered indications. The patient’s own report of pain, bleeding, or functional interference strengthens the necessity case, so record it in the clinical note.

• Covered indications generally include lesions that bleed, hurt, or catch on clothing. They also include lesions that have changed in appearance, are suspected to be pre-malignant, or interfere with function.
• Non-covered indications include cosmetic removal, removal for convenience, and removal of asymptomatic lesions with no clinical concern.

MAC policies vary. Some publish LCDs for benign lesion removal that name the covered ICD-10-CM codes outright. Check your MAC’s policy before you submit, and confirm the diagnosis code you plan to use appears on the covered list.

Common billing errors and how to avoid them

Most 11404 denials trace back to a small set of repeating mistakes. Knowing them in advance saves the rework.

• Wrong diameter tier: measuring the lesion alone drops the claim into a lower-paying tier. Always document the total excised diameter.
• Unbundling wound repair: billing a simple repair code alongside 11404 when the closure was integral to the excision. Simple closure is included in the excision code.
• Missing modifier: submitting multiple excisions on one date without modifier 51 on the secondary procedure. Payers expect the multiple-procedure discount to be signaled.
• Cosmetic diagnosis: using a cosmetic or unspecified ICD-10 code instead of one that reflects medical necessity. This is the primary non-coverage trigger for Medicare.
• No pathology report: a claim with no pathology on file is exposed to retrospective denial on audit.
• Wrong site series: using 11404 for a facial lesion instead of the 11440 series. The operative note gives it away and the claim is denied.
• Destruction billed as excision: lesions removed by cryotherapy or electrosurgery belong in the 17000 series, starting at 17000.

How Pabau supports accurate 11404 billing?

The errors above share one root cause. Clinical documentation lives in one system and CPT selection happens in another, so a measurement gets retyped and the tier stops matching the note. Practices running dermatology EMR software with billing built into the same record avoid that hand-off entirely.

In Pabau, the practitioner documents the excision once, including the site and the measured excised diameter. The system then surfaces the applicable CPT code from those inputs, and the ICD-10-CM diagnosis is attached at the same moment. No separate biller works from a printout, so you see fewer tier errors and fewer claims submitted without a required modifier.

Beyond individual claims, client records keep the pathology report alongside the procedure note, so the documentation package stays complete. That matters most when a payer asks for supporting records months later. Because everything is timestamped and searchable, a medical chart audit takes hours rather than days.

Stop losing revenue to preventable 11404 denials

Pabau links your clinical documentation directly to CPT code selection and claim submission. Dermatology and skin practices catch tier and modifier errors before the claim leaves the building.

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Conclusion

11404 rewards precision in one measurement and punishes vagueness everywhere else. If the operative note carries the total excised diameter in centimeters, the tier argues itself and the claim survives review. If it carries “lesion excised,” you are relying on a coder’s best guess.

So make the measurement a required field rather than a habit, and attach the pathology report before the claim goes out. The trade-off worth remembering is that a few seconds at the point of care buys you the audit defense you cannot build retrospectively.

Book a demo to see how Pabau turns your excision notes into clean 11404 claims for a dermatology or skin practice.

Continue your research

Excising a smaller lesion on the same sites? 11400 covers benign excisions with an excised diameter of 0.5 cm or less.

Shaving a lesion rather than excising it? 11313 covers shave removal on the trunk, arms, or legs above 2.0 cm.

Did pathology come back malignant at a smaller size? 11603 covers malignant excision on the trunk, arms, or legs at 2.1 to 3.0 cm.

Need authorization on file before releasing records? The HIPAA waiver form gives you a ready-to-use authorization for disclosing protected health information.

Preparing a wound bed before a graft? 15005 covers each additional 100 sq cm of recipient site preparation on the face, scalp, or neck.

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