CPT code 11305 is for the procedure of shaving a skin lesion that is 0.5 cm or smaller.
CPT code 11305 is used to describe the procedure of shaving a skin lesion that is 0.5 centimeters or smaller in diameter. This code is typically used by healthcare providers to document and bill for the removal of a superficial skin growth, such as a mole or wart, using a shaving technique. This procedure involves carefully removing the lesion with a blade or similar instrument, without cutting into the deeper layers of the skin.
For CPT code 11305, which pertains to the shaving of a skin lesion measuring 0.5 cm or less, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the same procedure is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient needs to return for a related procedure.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
7. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the procedure was planned or anticipated at the time of the original procedure.
8. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed at the same session by the same provider.
9. Modifier 22: Increased procedural services. This modifier is used when the work required to provide a service is substantially greater than typically required.
10. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
12. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. This modifier is used when an Advance Beneficiary Notice (ABN) is on file.
13. Modifier GX: Notice of liability issued, voluntary under payer policy. This modifier is used when a voluntary ABN was issued for a service.
14. Modifier GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit. This modifier is used when the service is not covered by Medicare.
15. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. This modifier is used when no ABN was issued, but the provider expects that Medicare will deny the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11305, which involves a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various services covered by Medicare. Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they can provide specific guidance and any regional variations in reimbursement policies.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 11305, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
