Billing code 11421: Lesion excisionMedicare rate & RVUs in Utah
Reports surgical removal of a benign skin lesion on the scalp, neck, hands, feet, or genitalia when the lesion and margins measure 0.6–1 cm.
Medicare pays $152.39 for 11421 in the office in Utah (Utah). 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 11421 covers
This code represents full-thickness surgical removal of a benign skin lesion from the scalp, neck, hands, feet, or genitalia. Dermatologists, primary care clinicians, and surgeons commonly perform the procedure in an office or outpatient setting. The reported size is the excised diameter: the lesion’s greatest diameter plus the narrowest margins needed for complete removal. The code is not selected by the length of the incision or the size of the specimen after removal.
Document the lesion’s site, benign diagnosis, excised diameter, and removal method. Routine simple closure is included; a separately performed intermediate or complex repair may be reported when its requirements are met. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and 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.
11421 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $152.39 | $95.56 |
How the 11421 rate is calculated
Each of 11421’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 · 11421
RVUs × geographic indexes × conversion factor
Work1.43
1.43 RVUs× 1.000 GPCI
Practice expense3.17
3.17 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
4.7700
Conversion factor
$33.4009
Medicare rate
$159.32
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 11421
11421 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11421
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 · 11421
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
11421 without 51 · national office
$159.32
Lesion excision
11421-51 · Second procedure: 50%
$79.66
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%).
11421 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 11420Benign lesion excision
- Use 11420 for a smaller excised diameter in the same scalp, neck, hands, feet, or genitalia site group. Include the lesion and necessary margins when measuring.
- 11422Skin lesion excision
- Use 11422 when the excised diameter falls in the next larger range for the same site group; 11421 is limited to 0.6–1 cm.
- 11401Benign lesion excision
- The size range may be similar, but 11401 is for the trunk, arms, or legs. Select the site-specific code before applying the diameter range.
- 11441Benign lesion excision
- 11441 is for the face or mucous membrane site group, not the scalp, neck, hands, feet, or genitalia group covered by 11421.
11421 billing questions
How is 11421 distinguished from 11420 or 11422?
Use the excised diameter, including the lesion and the narrowest margins needed for removal. 11421 is for 0.6–1 cm; 11420 is the smaller size range and 11422 the next larger range.
Which body sites qualify for this code?
The site group includes the scalp, neck, hands, feet, and genitalia. A similar-sized lesion on the trunk, arms, or legs belongs to a different site group.
Can the closure be billed separately?
Routine simple closure is included in the excision. A separately performed intermediate or complex repair may be reported when the repair service and documentation support it.
Should modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the services according to the applicable lesion and procedure coding rules rather than using modifier 50.
What documentation supports the size selection?
Record the anatomical site, benign lesion diagnosis, and excised diameter, calculated from the lesion’s greatest diameter plus the narrowest margins. The incision length alone does not establish the code’s size.
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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