SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Removal of Benign Skin Lesions

A57113

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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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General Information

Source Article ID
N/A
Article ID
A57113
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
09/26/2019
Revision Effective Date
03/17/2023
Revision Ending Date
10/17/2023
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34938, Removal of Benign Skin Lesions. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

According to the Current Procedural Terminology (CPT) Manual, appropriate code selection for lesion removal is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision. Please refer to the current CPT manual for further information.

Measurement is made prior to excision. Lesion compared to margin plus lesion should not differ significantly.

Do not report shave removal codes (11300 – 11313) when a tangential (shave) biopsy of the lesion is performed. Shave removal codes (11300 – 11313) include removal of tissue that may be submitted for pathological examination, biopsy code(s) should not be reported separately with these codes. Histopathologic examination of the lesion may be reported separately, see 88304-88305. When shave removal is performed with the sole intent of obtaining pathologic diagnosis, tangential biopsy CPT code(s) 11102-11103, should be reported.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

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Coding Information

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(76 Codes)
Group 1 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Please note not all ICD-10-CM codes apply to all CPT codes. Choose the correct procedure for the lesion being treated.

The following CPT/HCPCS codes associated with the services outlined in this policy will not have diagnosis limitations applied at this time: 11200, 11201, 17106, 17107, 17108, and 17340.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 11310, 11311, 11312, 11313, 11440, 11441, 11442, 11443, 11444, and 11446.

Group 1 Codes
Code Description
B07.8 Other viral warts
B08.1 Molluscum contagiosum
D17.0 Benign lipomatous neoplasm of skin and subcutaneous tissue of head, face and neck
D17.39 Benign lipomatous neoplasm of skin and subcutaneous tissue of other sites
D18.01 Hemangioma of skin and subcutaneous tissue
D18.09 Hemangioma of other sites
D18.1 Lymphangioma, any site
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
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
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
D37.01 Neoplasm of uncertain behavior of lip
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
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
H61.001 Unspecified perichondritis of right external ear
H61.002 Unspecified perichondritis of left external ear
H61.003 Unspecified perichondritis of external ear, bilateral
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
L29.9 Pruritus, unspecified
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L66.1 Lichen planopilaris
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
L81.4 Other melanin hyperpigmentation
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L90.5 Scar conditions and fibrosis of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L98.0 Pyogenic granuloma
Q82.5 Congenital non-neoplastic nevus
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.09 Other neurofibromatosis
R20.8 Other disturbances of skin sensation
R23.3 Spontaneous ecchymoses
R23.8 Other skin changes
R52 Pain, unspecified
R58 Hemorrhage, not elsewhere classified

Group 2

(56 Codes)
Group 2 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 11300, 11301, 11302, 11303, 11400, 11401, 11402, 11403, 11404, and 11406.

Group 2 Codes
Code Description
B07.8 Other viral warts
B08.1 Molluscum contagiosum
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
D18.1 Lymphangioma, any site
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
D23.5 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
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
L29.9 Pruritus, unspecified
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L66.1 Lichen planopilaris
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
L81.4 Other melanin hyperpigmentation
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L85.0 Acquired ichthyosis
L85.3 Xerosis cutis
L85.8 Other specified epidermal thickening
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L90.5 Scar conditions and fibrosis of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L92.0 Granuloma annulare
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L95.1 Erythema elevatum diutinum
L98.0 Pyogenic granuloma
Q82.5 Congenital non-neoplastic nevus
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.09 Other neurofibromatosis
R20.8 Other disturbances of skin sensation
R23.3 Spontaneous ecchymoses
R23.8 Other skin changes
R52 Pain, unspecified
R58 Hemorrhage, not elsewhere classified

Group 3

(62 Codes)
Group 3 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS Codes: 11305, 11306, 11307, and 11308.

Group 3 Codes
Code Description
A63.0 Anogenital (venereal) warts
B07.0 Plantar wart
B07.8 Other viral warts
B08.1 Molluscum contagiosum
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
D18.1 Lymphangioma, any site
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
D23.4 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
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
L29.9 Pruritus, unspecified
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L66.1 Lichen planopilaris
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
L81.4 Other melanin hyperpigmentation
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)
L85.3 Xerosis cutis
L85.8 Other specified epidermal thickening
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L90.5 Scar conditions and fibrosis of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L92.0 Granuloma annulare
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L95.1 Erythema elevatum diutinum
L98.0 Pyogenic granuloma
N48.89 Other specified disorders of penis
Q82.5 Congenital non-neoplastic nevus
R20.8 Other disturbances of skin sensation
R23.3 Spontaneous ecchymoses
R23.8 Other skin changes
R52 Pain, unspecified
R58 Hemorrhage, not elsewhere classified

Group 4

(68 Codes)
Group 4 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 11420, 11421, 11422, 11423, 11424, and 11426.

Group 4 Codes
Code Description
A63.0 Anogenital (venereal) warts
B07.0 Plantar wart
B07.8 Other viral warts
B08.1 Molluscum contagiosum
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
D18.1 Lymphangioma, any site
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
D23.4 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
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
L29.9 Pruritus, unspecified
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L66.1 Lichen planopilaris
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
L81.4 Other melanin hyperpigmentation
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L85.0 Acquired ichthyosis
L85.3 Xerosis cutis
L85.8 Other specified epidermal thickening
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L90.5 Scar conditions and fibrosis of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L92.0 Granuloma annulare
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L95.1 Erythema elevatum diutinum
L98.0 Pyogenic granuloma
N48.89 Other specified disorders of penis
N75.0 Cyst of Bartholin's gland
N90.0 Mild vulvar dysplasia
N90.1 Moderate vulvar dysplasia
N90.3 Dysplasia of vulva, unspecified
N90.7 Vulvar cyst
Q82.5 Congenital non-neoplastic nevus
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.09 Other neurofibromatosis
R20.8 Other disturbances of skin sensation
R23.3 Spontaneous ecchymoses
R23.8 Other skin changes
R52 Pain, unspecified
R58 Hemorrhage, not elsewhere classified

Group 5

(65 Codes)
Group 5 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 17000, 17003, 17004, 17110, and 17111.

Group 5 Codes
Code Description
A63.0 Anogenital (venereal) warts
B07.0 Plantar wart
B07.8 Other viral warts
B08.1 Molluscum contagiosum
D18.01 Hemangioma of skin and subcutaneous tissue
D18.1 Lymphangioma, any site
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
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
L29.9 Pruritus, unspecified
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L66.1 Lichen planopilaris
L72.0 Epidermal cyst
L72.2 Steatocystoma multiplex
L72.3 Sebaceous cyst
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L81.4 Other melanin hyperpigmentation
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L85.0 Acquired ichthyosis
L85.3 Xerosis cutis
L85.8 Other specified epidermal thickening
L87.0 Keratosis follicularis et parafollicularis in cutem penetrans
L90.5 Scar conditions and fibrosis of skin
L91.0 Hypertrophic scar
L91.8 Other hypertrophic disorders of the skin
L92.0 Granuloma annulare
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L95.1 Erythema elevatum diutinum
L98.0 Pyogenic granuloma
Q82.5 Congenital non-neoplastic nevus
R20.8 Other disturbances of skin sensation
R23.3 Spontaneous ecchymoses
R23.8 Other skin changes
R52 Pain, unspecified
R58 Hemorrhage, not elsewhere classified

Group 6

(10 Codes)
Group 6 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 46900, 46916, 54050, 54055, 54056, 54057, 54060, and 54065.

Group 6 Codes
Code Description
A54.1 Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess
A63.0 Anogenital (venereal) warts
B08.1 Molluscum contagiosum
D48.5 Neoplasm of uncertain behavior of skin
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
L44.8 Other specified papulosquamous disorders
L45 Papulosquamous disorders in diseases classified elsewhere
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue

Group 7

(14 Codes)
Group 7 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 56501 and 56515.

Group 7 Codes
Code Description
A54.02 Gonococcal vulvovaginitis, unspecified
A54.1 Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess
A63.0 Anogenital (venereal) warts
B08.1 Molluscum contagiosum
D07.1 Carcinoma in situ of vulva
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
L44.8 Other specified papulosquamous disorders
L45 Papulosquamous disorders in diseases classified elsewhere
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
N90.0 Mild vulvar dysplasia
N90.1 Moderate vulvar dysplasia
N90.3 Dysplasia of vulva, unspecified

Group 8

(119 Codes)
Group 8 Paragraph

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes are the only malignant diagnoses that are appropriate, and their use is limited to CPT codes: 11300-11313.

Group 8 Codes
Code Description
C44.00 Unspecified malignant neoplasm of skin of lip
C44.01 Basal cell carcinoma of skin of lip
C44.02 Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C44.202 Unspecified malignant neoplasm of skin of right ear and external auricular canal
C44.209 Unspecified malignant neoplasm of skin of left ear and external auricular canal
C44.212 Basal cell carcinoma of skin of right ear and external auricular canal
C44.219 Basal cell carcinoma of skin of left ear and external auricular canal
C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal
C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal
C44.292 Other specified malignant neoplasm of skin of right ear and external auricular canal
C44.299 Other specified malignant neoplasm of skin of left ear and external auricular canal
C44.301 Unspecified malignant neoplasm of skin of nose
C44.309 Unspecified malignant neoplasm of skin of other parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.391 Other specified malignant neoplasm of skin of nose
C44.399 Other specified malignant neoplasm of skin of other parts of face
C44.40 Unspecified malignant neoplasm of skin of scalp and neck
C44.41 Basal cell carcinoma of skin of scalp and neck
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.500 Unspecified malignant neoplasm of anal skin
C44.501 Unspecified malignant neoplasm of skin of breast
C44.509 Unspecified malignant neoplasm of skin of other part of trunk
C44.510 Basal cell carcinoma of anal skin
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.520 Squamous cell carcinoma of anal skin
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.590 Other specified malignant neoplasm of anal skin
C44.591 Other specified malignant neoplasm of skin of breast
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C44.602 Unspecified malignant neoplasm of skin of right upper limb, including shoulder
C44.609 Unspecified malignant neoplasm of skin of left upper limb, including shoulder
C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder
C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder
C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder
C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder
C44.692 Other specified malignant neoplasm of skin of right upper limb, including shoulder
C44.699 Other specified malignant neoplasm of skin of left upper limb, including shoulder
C44.702 Unspecified malignant neoplasm of skin of right lower limb, including hip
C44.709 Unspecified malignant neoplasm of skin of left lower limb, including hip
C44.712 Basal cell carcinoma of skin of right lower limb, including hip
C44.719 Basal cell carcinoma of skin of left lower limb, including hip
C44.722 Squamous cell carcinoma of skin of right lower limb, including hip
C44.729 Squamous cell carcinoma of skin of left lower limb, including hip
C44.792 Other specified malignant neoplasm of skin of right lower limb, including hip
C44.799 Other specified malignant neoplasm of skin of left lower limb, including hip
C44.80 Unspecified malignant neoplasm of overlapping sites of skin
C44.81 Basal cell carcinoma of overlapping sites of skin
C44.82 Squamous cell carcinoma of overlapping sites of skin
C44.89 Other specified malignant neoplasm of overlapping sites of skin
C51.0 Malignant neoplasm of labium majus
C51.1 Malignant neoplasm of labium minus
C51.2 Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C51.9 Malignant neoplasm of vulva, unspecified
C52 Malignant neoplasm of vagina
C57.7 Malignant neoplasm of other specified female genital organs
C57.8 Malignant neoplasm of overlapping sites of female genital organs
C57.9 Malignant neoplasm of female genital organ, unspecified
C60.0 Malignant neoplasm of prepuce
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C63.2 Malignant neoplasm of scrotum
C63.7 Malignant neoplasm of other specified male genital organs
C63.8 Malignant neoplasm of overlapping sites of male genital organs
C63.9 Malignant neoplasm of male genital organ, unspecified
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.21 Melanoma in situ of right ear and external auricular canal
D03.22 Melanoma in situ of left ear and external auricular canal
D03.39 Melanoma in situ of other parts of face
D03.51 Melanoma in situ of anal skin
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
D03.71 Melanoma in situ of right lower limb, including hip
D03.72 Melanoma in situ of left lower limb, including hip
D03.8 Melanoma in situ of other sites
D04.0 Carcinoma in situ of skin of lip
D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
D04.21 Carcinoma in situ of skin of right ear and external auricular canal
D04.22 Carcinoma in situ of skin of left ear and external auricular canal
D04.39 Carcinoma in situ of skin of other parts of face
D04.4 Carcinoma in situ of skin of scalp and neck
D04.5 Carcinoma in situ of skin of trunk
D04.61 Carcinoma in situ of skin of right upper limb, including shoulder
D04.62 Carcinoma in situ of skin of left upper limb, including shoulder
D04.71 Carcinoma in situ of skin of right lower limb, including hip
D04.72 Carcinoma in situ of skin of left lower limb, including hip
D04.8 Carcinoma in situ of skin of other sites
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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

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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.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
03/17/2023 R3

Article revised and published on 6/15/2023 effective for dates of service on and after 3/17/2023. The following ICD-10-CM codes have been added to ICD-10-CM codes that support medical necessity for code group 4: N90.0, N 90.1, N90.3. This revision is in response to an inquiry.

01/12/2022 R2

Article revised and published on 04/07/2022 effective for dates of service on and after 01/12/2022. The following ICD-10-CM codes have been added to the ICD-10-CM codes that support medical necessity for code groups 1, 2, and 4: Q85.01, Q85.02, Q85.09. This revision is in response to an inquiry. Minor formatting revisions were made throughout the article.

08/27/2021 R1

Article revised and published on 12/09/2021 effective for dates of service on and after 08/27/2021. A new CPT group (Group 8), and a new ICD-10-CM group (Group 8) have been added as a response to an inquiry. The ICD-10-CM Group 8 Paragraph was updated to reflect that the listed ICD-10-CM codes are the only malignant diagnoses that are appropriate, and their use is limited to CPT codes 11300-11313. A statement was also added in the Coding Guidance section of the article. Minor formatting changes have been made throughout the article.

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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
L34938 - 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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Updated On Effective Dates Status
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06/09/2023 03/17/2023 - 10/17/2023 Superseded You are here
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Keywords

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