Billing code 11401: Benign lesion excisionMedicare rate & RVUs in Illinois
Reports excision of a benign skin lesion on the trunk, arms, or legs when the lesion and narrowest margins measure 0.6 through 1.0 cm.
Medicare pays $148.60–$162.73 for 11401 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 11401 covers
A physician or other qualified practitioner excises a benign skin lesion from the trunk or an extremity, removing the lesion through the dermis with the margins needed for complete removal. Typical office cases include excision of a benign nevus or cyst from the back, arm, or leg. The code family is organized by both anatomic site and the diameter of the excised area, not by the lesion’s appearance alone.
Choose this level using the greatest diameter of the lesion plus the narrowest margins required for excision; document the site and measurement. Simple closure is included, while a separately performed intermediate or complex repair may be reported when its requirements are met and documented. Related postoperative visits during the 10-day global period are included. For multiple procedures in one session, CMS pays the highest-valued procedure in full and reduces the others to 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 11401 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$148.60 to $162.73
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $162.73 | $101.97 |
| East St. Louis | $151.77 | $96.15 |
| Rest Of Illinois | $148.60 | $93.41 |
| Suburban Chicago | $162.31 | $100.22 |
How the 11401 rate is calculated
Each of 11401’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 11401
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.25Practice expense 3.23Malpractice 0.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11401
11401 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11401
Benign lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 11401
Benign lesion excision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11401 without 51 · national office
$154.98
Benign lesion excision
11401-51 · Second procedure: 50%
$77.49
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
11401 compared with similar codes
Compare codes
11401 vs 11400 vs 11402 vs 11421 vs 11441: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11400Skin lesion excision
- Both cover benign-lesion excision on the trunk or extremities; 11400 is for an excised diameter below 0.6 cm, while 11401 covers 0.6 through 1.0 cm.
- 11402Skin lesion excision
- Both cover the same sites, but 11402 applies when the excised diameter is 1.1 through 2.0 cm.
- 11421Lesion excision
- The size range matches, but 11421 is for the scalp, neck, hands, or feet rather than the trunk, arms, or legs.
- 11441Benign lesion excision
- The size range matches, but 11441 is for the face and related sites, not the trunk or extremities.
11401 billing questions
How is the 0.6–1 cm size determined?
Measure the lesion together with the narrowest margins removed, using the greatest diameter of the excised area. Document the measurement and the anatomic site.
When should I use 11401 instead of 11400 or 11402?
Use 11401 for a trunk or extremity excision measuring 0.6 through 1.0 cm. Code 11400 is for the smaller size level, and 11402 is for the next larger level.
Does the excision code include wound closure?
Simple closure is included. A separately performed intermediate or complex repair may be reported when the repair independently meets the applicable requirements and is documented.
Can I use 11401 for a lesion on the face or scalp?
No. This code is for the trunk, arms, and legs; select the excision family for the actual site, such as the separate face or scalp, neck, hands, and feet families.
Are postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple procedure reduction, with payment at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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