Removal of Benign or Premalignant Skin Lesions

Section: Surgery
Effective Date: September 01, 2019
Revised Date: May 19, 2020
Last Reviewed: May 19, 2020

Description

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

Criteria

Removal of a benign skin lesion (e.g., skin tags, 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 meet above criteria considered cosmetic, and therefore considered non-covered.

Procedure Codes

11200 11201

Diagnosis Codes

A63.0 B07.0 B07.8 B07.9 B08.1 D17.0 D17.1
D17.20 D17.21 D17.22 D17.23 D17.24 D17.30 D17.39
D22.0 D22.4 D22.5 D22.9 D22.10 D22.111 D22.112
D22.121 D22.122 D22.20 D22.21 D22.22 D22.30 D22.39
D22.60 D22.61 D22.62 D22.70 D22.71 D22.72 D23.0
D23.4 D23.5 D23.9 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 D48.5 D48.7
D48.9 D49.2 H02.821 H02.822 H02.823 H02.824 H02.825
H02.826 H02.829 I78.1 L72.0 L72.3 L82.0 L82.1
L98.0 Z85.820 Z85.828

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 7-16-2019 Coding update

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.