CPT code 11401 is for the excision of a benign skin lesion, including margins, measuring 0.6 to 1 cm.
CPT code 11401 is used to describe the excision of a benign (non-cancerous) skin lesion, including the margins, with a diameter of 0.6 to 1.0 centimeters. This code is specific to procedures where the lesion is removed from areas other than the face, ears, eyelids, nose, lips, or mucous membrane.
For CPT code 11401, which pertains to the excision of a benign lesion including margins with a diameter of 0.6 to 1.0 cm, 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 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day by a different provider.
7. 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 had to return to the operating room for a related procedure.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the procedure was unrelated to the original procedure and performed during the postoperative period.
9. Modifier LT: Left side. Use this modifier to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier to indicate that the procedure was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. Use this modifier if an Advance Beneficiary Notice (ABN) was issued for a service that may not be covered by Medicare.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier when a voluntary ABN was issued for a service that is statutorily excluded or does not meet the definition of any Medicare benefit.
13. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. Use this modifier when an ABN was not issued, and the provider expects Medicare to deny the service as not reasonable and necessary.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11401 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 11401. However, the final reimbursement amount is often determined by the Medicare Administrative Contractor (MAC) for your specific region. Each MAC may have slight variations in how they interpret and apply the MPFS, so it is essential to check with your local MAC for the most accurate and up-to-date reimbursement information for CPT code 11401.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 11401. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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