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Removal of Benign or Premalignant Skin Lesions

Section: Surgery
Effective Date: September 01, 2019
Revised Date: August 13, 2019
Last Reviewed: July 16, 2019

Description

Lesions that cause irritation, pain or bleeding may require removal to alleviate symptoms. Surgical removal is also recommended for any lesion that showspossible signs of malignancy. 

Criteria 

Removal of a benign skin lesion (e.g., nevus [mole], sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met: 

  • There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or
  • Inflammation, as evidenced by purulence, oozing, edema, erythema, etc.; or
  • The lesion obstructs a body orifice, or restricts vision; or
  • There is clinical suspicion of malignancy (e.g., a change in the ABCDEs of skin cancer [asymmetry, border irregularity, color, diameter, evolving or
    changing in size, shape or color]); or
  • Due to its anatomical location, the lesion is prone to being recurrently traumatized; or
  • A prior biopsy suggests or is indicative of lesion malignancy.

Removal of a benign skin lesion (e.g., nevus [mole], sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) not meeting above criteria is considered not medically necessary.

Procedure Codes

11300 11301 11302 11303 11305 11306 11307
11308 11310 11311 11312 11313 11400 11401
11402 11403 11404 11406 11420 11421 11422
11423 11424 11426 11440 11441 11442 11443
11444 11446 17110 17111

Removal of skin tags that do not pose a threat to health or function are considered cosmetic, and therefore considered non-covered. 

Procedure Codes

11200 11201

Diagnosis Codes

A63.0 B07.0 B07.8 B07.9 B08.1 D10.0 D17.0
D17.1 D17.20 D17.21 D17.22 D17.23 D17.24 D17.30
D17.39 D21.0 D22.0 D22.111 D22.112 D22.121 D22.122
D22.20 D22.21 D22.22 D22.4 D22.5 D22.61 D22.62
D22.71 D22.72 D23.0 D23.4 D23.5 D23.10 D23.111
D23.112 D23.121 D23.122 D23.20 D23.21 D23.22 D23.30
D23.39 D23.60 D23.61 D23.62 D23.70 D23.71 D23.72
D37.01 D48.1 D48.5 D48.61 D48.62 D48.7 H02.821
H02.822 H02.823 H02.824 H02.825 H02.826 I78.1 K13.21
L72.0 L72.11 L72.12 L72.3 L82.0 L82.1 L98.0
Z85.820 Z85.821 Z85.828

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