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LCD Reference Article Billing and Coding Article

Billing and Coding: Removal of Benign Skin Lesions

A57482

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57482
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Removal of Benign Skin Lesions
Article Type
Billing and Coding
Original Effective Date
10/31/2019
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

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CMS National Coverage Policy

CMS Pub.100-02 Medicare Benefit Policy Manual, Chapter 16 - General Exclusions From Coverage, Section §120 - Cosmetic Surgery

CMS Pub. 100-03 Medicare National Coverage Determinations Manual-Chapter 1, Coverage Determinations, Part 4, Section 250.4 - Treatment of Actinic Keratosis

CMS Pub.100-04 Medicare Claims Processing Manual, Ch. 23 Fee Schedule Administration and Coding Requirements, Section 10.1-10.6 – Reporting ICD Diagnosis and Procedure Codes

Title XVIII of the Social Security Act, section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.

CMS Transmittal No, 863, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L35498 Removal of Benign Skin Lesions.

Coding Information

  1. Use the CPT code that best describes the procedure, the location and the size of the lesion. If there are multiple lesions treated, multiple codes may be reported but you must follow National Correct Coding Initiative guidelines.

    CPT code 11200 should be reported with one unit of service. CPT code 11201 should be reported with 1 unit for each additional group of 10 lesions.

    CPT code 17110 should be reported with one unit of service for removal of benign lesions other than skin tags or cutaneous vascular lesions, up to 14 lesions. CPT code 17111 should be reported with one unit of service for removal of benign lesions other than skin tags or cutaneous vascular lesions, representing 15 or more.

    CPT codes 11400-11446 should be used when the excision is a full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure.

  2. The provider should use the appropriate CPT code and the diagnosis code should match the CPT code. If a provider bills a benign skin lesion CPT code, it is not correct to use a malignant diagnosis code.
  3. If a beneficiary wishes to have one or more benign asymptomatic lesions removed that pose no threat to health or function, and for cosmetic purposes:
    1. The physician should explain to the patient, in advance, that Medicare will not cover cosmetic cutaneous surgery and that the beneficiary will be liable for the cost of the service. Charges should be clearly stated. A claim for cosmetic services does not need to be submitted to the Medicare Contractor unless the patient requests that the claim be submitted on his/her behalf.
    2. When the patient requests the claim for cosmetic services be submitted on his/her behalf, the services should be reported with modifier GY (items or services statutorily excluded or does not meet the definition of any Medicare benefit) and diagnosis code Z41.1.
  4. Evaluation and management services provided on the day, or the day before a dermatological procedure, for the purpose of making the decision to perform the procedure, are not payable. The modifier -57 cannot be used since the decision to perform the dermatological procedure is considered a routine preoperative service and a visit or consultation should not be billed. (Modifier -57 is only applicable for major procedures that have a 90-day global period.)
    Please refer to Modifier-57 Fact Sheet on WPS GHA website.
  5. An E&M service reported on the same day as a dermatological surgery is subject to the Medicare global surgery rules and will only be payable if a significant and separately identifiable medical service is rendered and clearly documented in the patient's medical record. A modifier-25 should be appended to the appropriate visit code to indicate the patient's condition required a significant, separately identifiable visit service in addition to the procedure that was performed.
    Please refer to Modifier-25 Fact Sheet on WPS GHA website.

    Removal of benign lesions is elective surgery and generally pre-scheduled. It is inappropriate to report an E&M service with a -25 modifier on the same date of service as these surgeries for the usual pre/post-operative care associated with these surgeries.
  6. When billing the destruction of multiple other benign lesions use CPT 17110 or 17111 with a “1” in the unit box. CPT 17110 and CPT 17111 may not be reported together.

Providers should bill the appropriate CPT code and match the diagnosis code to the procedure code.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

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Group 1

(37 Codes)
Group 1 Paragraph

CPT codes 11300-11313 may also be covered for the removal of cancerous skin lesions which are not addressed in this LCD

 Group 1 Codes
Code Description
11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
11201 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10 LESIONS, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
11300 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS
11301 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM
11302 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
11303 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 2.0 CM
11305 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS
11306 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
11307 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM
11308 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 2.0 CM
11310 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS
11311 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
11312 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM
11313 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER OVER 2.0 CM
11400 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS
11401 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM
11402 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
11403 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
11404 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
11406 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
11420 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
11421 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 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 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
11424 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM
11426 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
11440 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 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 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 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 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 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
17106 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM
17107 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0 TO 50.0 SQ CM
17108 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM
17110 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
17111 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS
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CPT/HCPCS Modifiers

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Group 1

(3 Codes)
Group 1 Paragraph

N/A

 Group 1 Codes
Code Description
25 SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE: THE PHYSICIAN MAY NEED TO INDICATE THAT ON THE DAY A PROCEDURE OR SERVICE IDENTIFIED BY A CPTCODE WAS PERFORMED, THE PATIENT'S CONDITION REQUIRED A SIGNIFICANT, SEPARATELY IDENTIFIABLE E/M SERVICE ABOVE AND BEYOND THE OTHER SERVICE PROVIDED OR BEYOND THE USUAL PREOPERATIVE AND POSTOPERATIVE CARE ASSOCIATED WITH THE PROCEDURE THAT WAS PERFORMED. THE E/M SERVICE MAY BE PROMPTED BY THE SYMPTOM OR CONDITION FOR WHICH THE PROCEDURE AND/OR SERVICE WAS PROVIDED. AS SUCH, DIFFERENT DIAGNOSES ARE NOT REQUIRED FOR REPORTING OF THE E/M SERVICES ON THE SAME DATE. THIS CIRCUMSTANCE MAY BE REPORTED BY ADDING THE MODIFIER -25 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09925 MAY BE USED. NOTE: THIS MODIFIER IS NOT USED TO REPORT AN E/M SERVICE THAT RESULTED IN A DECISION TO PERFORM SURGERY. SEE MODIFIER -57.
57 DECISION FOR SURGERY: AN EVALUATION AND MANAGEMENT SERVICE THAT RESULTED IN THE INITIAL DECISION TO PERFORM THE SURGERY, MAY BE IDENTIFIED BY ADDING THE MODIFIER -57 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09957 MAY BE USED.
GY ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT
N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(138 Codes)
Group 1 Paragraph

National Coverage Determination 250.4 outlines coverage for the treatment of actinic keratosis (AK) diagnosis code L57.0

 Group 1 Codes
Code Description
A63.0 Anogenital (venereal) warts
B07.0 Plantar wart
B07.8 Other viral warts
B07.9 Viral wart, unspecified
B08.1 Molluscum contagiosum
D10.0 Benign neoplasm of lip
D10.39 Benign neoplasm of other parts of mouth
D17.0 Benign lipomatous neoplasm of skin and subcutaneous tissue of head, face and neck
D17.1 Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk
D17.21 Benign lipomatous neoplasm of skin and subcutaneous tissue of right arm
D17.22 Benign lipomatous neoplasm of skin and subcutaneous tissue of left arm
D17.23 Benign lipomatous neoplasm of skin and subcutaneous tissue of right leg
D17.24 Benign lipomatous neoplasm of skin and subcutaneous tissue of left leg
D17.39 Benign lipomatous neoplasm of skin and subcutaneous tissue of other sites
D18.01 Hemangioma of skin and subcutaneous tissue
D22.0 Melanocytic nevi of lip
D22.111 Melanocytic nevi of right upper eyelid, including canthus
D22.112 Melanocytic nevi of right lower eyelid, including canthus
D22.121 Melanocytic nevi of left upper eyelid, including canthus
D22.122 Melanocytic nevi of left lower eyelid, including canthus
D22.21 Melanocytic nevi of right ear and external auricular canal
D22.22 Melanocytic nevi of left ear and external auricular canal
D22.39 Melanocytic nevi of other parts of face
D22.4 Melanocytic nevi of scalp and neck
D22.5 Melanocytic nevi of trunk
D22.61 Melanocytic nevi of right upper limb, including shoulder
D22.62 Melanocytic nevi of left upper limb, including shoulder
D22.71 Melanocytic nevi of right lower limb, including hip
D22.72 Melanocytic nevi of left lower limb, including hip
D23.0 Other benign neoplasm of skin of lip
D23.111 Other benign neoplasm of skin of right upper eyelid, including canthus
D23.112 Other benign neoplasm of skin of right lower eyelid, including canthus
D23.121 Other benign neoplasm of skin of left upper eyelid, including canthus
D23.122 Other benign neoplasm of skin of left lower eyelid, including canthus
D23.21 Other benign neoplasm of skin of right ear and external auricular canal
D23.22 Other benign neoplasm of skin of left ear and external auricular canal
D23.39 Other benign neoplasm of skin of other parts of face
D23.4 Other benign neoplasm of skin of scalp and neck
D23.5 Other benign neoplasm of skin of trunk
D23.61 Other benign neoplasm of skin of right upper limb, including shoulder
D23.62 Other benign neoplasm of skin of left upper limb, including shoulder
D23.71 Other benign neoplasm of skin of right lower limb, including hip
D23.72 Other benign neoplasm of skin of left lower limb, including hip
D23.9 Other benign neoplasm of skin, unspecified
D28.0 Benign neoplasm of vulva
D28.1 Benign neoplasm of vagina
D29.0 Benign neoplasm of penis
D29.4 Benign neoplasm of scrotum
D37.01 Neoplasm of uncertain behavior of lip
D37.02 Neoplasm of uncertain behavior of tongue
D37.04 Neoplasm of uncertain behavior of the minor salivary glands
D37.05 Neoplasm of uncertain behavior of pharynx
D37.09 Neoplasm of uncertain behavior of other specified sites of the oral cavity
D40.8 Neoplasm of uncertain behavior of other specified male genital organs
D48.5 Neoplasm of uncertain behavior of skin
H00.11 Chalazion right upper eyelid
H00.12 Chalazion right lower eyelid
H00.14 Chalazion left upper eyelid
H00.15 Chalazion left lower eyelid
H02.61 Xanthelasma of right upper eyelid
H02.62 Xanthelasma of right lower eyelid
H02.64 Xanthelasma of left upper eyelid
H02.65 Xanthelasma of left lower eyelid
H02.821 Cysts of right upper eyelid
H02.822 Cysts of right lower eyelid
H02.824 Cysts of left upper eyelid
H02.825 Cysts of left lower eyelid
H61.011 Acute perichondritis of right external ear
H61.012 Acute perichondritis of left external ear
H61.013 Acute perichondritis of external ear, bilateral
H61.021 Chronic perichondritis of right external ear
H61.022 Chronic perichondritis of left external ear
H61.023 Chronic perichondritis of external ear, bilateral
H61.031 Chondritis of right external ear
H61.032 Chondritis of left external ear
H61.033 Chondritis of external ear, bilateral
I78.1 Nevus, non-neoplastic
K13.21 Leukoplakia of oral mucosa, including tongue
K13.3 Hairy leukoplakia
K13.5 Oral submucous fibrosis
K62.82 Dysplasia of anus
K64.4 Residual hemorrhoidal skin tags
L11.0 Acquired keratosis follicularis
L11.8 Other specified acantholytic disorders
L28.1 Prurigo nodularis
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L66.4 Folliculitis ulerythematosa reticulata
L72.0 Epidermal cyst
L72.11 Pilar cyst
L72.12 Trichodermal cyst
L72.2 Steatocystoma multiplex
L72.3 Sebaceous cyst
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L85.0 Acquired ichthyosis
L85.1 Acquired keratosis [keratoderma] palmaris et plantaris
L85.2 Keratosis punctata (palmaris et plantaris)
L85.8 Other specified epidermal thickening
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L87.1 Reactive perforating collagenosis
L87.2 Elastosis perforans serpiginosa
L87.8 Other transepidermal elimination disorders
L90.3 Atrophoderma of Pasini and Pierini
L90.4 Acrodermatitis chronica atrophicans
L90.5 Scar conditions and fibrosis of skin
L90.8 Other atrophic disorders of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L91.9 Hypertrophic disorder of the skin, unspecified
L92.2 Granuloma faciale [eosinophilic granuloma of skin]
L92.3 Foreign body granuloma of the skin and subcutaneous tissue
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L98.0 Pyogenic granuloma
L98.5 Mucinosis of the skin
L98.6 Other infiltrative disorders of the skin and subcutaneous tissue
L99 Other disorders of skin and subcutaneous tissue in diseases classified elsewhere
N75.0 Cyst of Bartholin's gland
N84.3 Polyp of vulva
N90.0 Mild vulvar dysplasia
N90.1 Moderate vulvar dysplasia
Q18.1 Preauricular sinus and cyst
Q82.1 Xeroderma pigmentosum
Q82.3 Incontinentia pigmenti
Q82.5 Congenital non-neoplastic nevus
Q82.8 Other specified congenital malformations of skin
Q85.01 Neurofibromatosis, type 1
Q85.03 Schwannomatosis
Q85.09 Other neurofibromatosis
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R22.2 Localized swelling, mass and lump, trunk
R22.31 Localized swelling, mass and lump, right upper limb
R22.32 Localized swelling, mass and lump, left upper limb
R22.33 Localized swelling, mass and lump, upper limb, bilateral
R22.41 Localized swelling, mass and lump, right lower limb
R22.42 Localized swelling, mass and lump, left lower limb
R22.43 Localized swelling, mass and lump, lower limb, bilateral
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

(1 Code)
Group 1 Paragraph

In the absence of signs, symptoms, illness or injury, Z41.1 should be reported, and payment will be denied. (Ref. CMS Pub.100-04 Medicare Claims Processing Manual, Ch. 23 §§10.1-10.6)

 Group 1 Codes
Code Description
Z41.1 Encounter for cosmetic surgery
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ICD-10-PCS Codes

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R6

Posted 02/01/2024 Under Coding Information CPT/HCPCS Codes Group 1 Codes, CPT codes 11200 and 11201 had description changes. This is due to the 2024 CPT/HCPCS Annual Updates and is effective 01/01/2024.
12/28/2023 R5

Posted 12/28/2023 Under ICD-10 Codes that Support Medical Necessity Group 1 Codes added ICD-10 code L56.5 due to a provider request for coverage.
11/30/2023 R4

Posted 11/30/2023- Under ICD-10 Codes that Support Medical Necessity Group 1 Codes added L28.1 due to a provider request for coverage.
10/26/2023 R3

Posted 10/26/2023- Under CMS National Coverage Policy updated references to current. Under ICD-10 Codes that DO NOT Support Medical Necessity Group 1 Paragraph reference was changed to CMS Pub.100-04 Medicare Claims Processing Manual, Ch. 23 §10.1-10.6. Review completed 9/14/2023.
06/01/2022 R2

Posted 09/29/2022 Under ICD-10 Codes that Support Medical Necessity Group 1 Codes, added ICD 10 code K62.82 effective 06/01/2022.
10/28/2021 R1

10/28/2021 Under Coding Information removed #7 paragraph as it was duplicate information on E/M services and modifier 25. Formatting changes made under CMS National Coverage Policy. Review completed 9/14/2021.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35498 - Removal of Benign Skin Lesions
Related National Coverage Documents
NCDs
250.4 - Treatment of Actinic Keratosis
SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Updated On Effective Dates Status
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