What is CPT code 11421?

CPT 11421 is used by healthcare providers to document and receive reimbursement for excision of benign lesions including margins for specific body areas, with an excised diameter of 0.6 cm to 1.0 cm.

What factors affect CPT fee schedules?

Factors affecting fee schedules include Medicare & Medicaid rates, private insurance negotiated rates, geographic location, and provider type (e.g., hospital vs. private practice).

How does CPT 11421 compare to other codes?

The CPT 11421 code is part of Surgery services for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and typically involves more provider time and moderate medical decision-making compared to lower-level codes.

Who publishes these rates?

PayerPrice displays the exact negotiated rates that insurers publish under federal transparency rules, directly from their public files, providing the same information they make public.

How can I find out the cost of a medical procedure?

To find out the cost of a specific medical procedure, it's best to look up the fee schedule using its CPT (Current Procedural Terminology) code and your specific location. You can use tools like Payerprice, which has a fee schedule lookup tool for users to search with CPT code and specific location, to get an estimate of what providers in your area might charge.

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are essential for billing and reporting healthcare services to insurance companies and government payers.

Where can I look up Medicare fee schedules?

For general information on Medicare fee schedules, the official source is the Centers for Medicare & Medicaid Services (CMS) website. However, if you are looking for specific pricing information for a procedure covered by Medicare in your location, it's recommended to use a tool like Payerprice, which allows you to search with a CPT code and specific location to get relevant fee schedules and cost estimates.

How do I know what my insurance will cover?

To understand what your insurance plan will cover, the best approach is to contact your insurance provider directly. You can typically find a customer service number on your insurance card or by logging into their member portal. They can provide details on your specific benefits, deductibles, co-pays, and co-insurance for various services.

Is there a tool to compare prices for medical services in my area?

Yes, there are tools designed to help you compare prices for medical services. For instance, Payerprice offers a fee schedule lookup tool where you can search with a specific CPT code and your location to find out potential costs for medical services in your area, helping you compare different providers.

CPT 11421 Fee Schedule

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Exc H F Nk Sp B9 Marg 0 6 1, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Scalp Neck Hands Feet Genitalia Excised Diameter 0 6 To 1 0 Cm

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Integumentary System
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None 59 - Distinct Procedural Service 51 - Multiple procedures
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 11421
Medicaid Fee Schedule	View Medicaid rates for 11421

National average reimbursement for CPT 11421 by major payers:

$172.57

$198.13

$208.94

$183.41

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 11421.

CPT 11421

5 of 25 sample ratesHigher to lower in this preview

Baycare Aurora Kaukauna Surgery Center LLC, Kaukauna Surgery Center
Baycare Aurora Kaukauna Surgery Center LLC
WIAmbulatory Surgical Clinic/CenterNPI 1821614710Tax ID 85-1420464
$2,498.00Published rate
Braselton Endoscopy Center, LLC
Braselton Endoscopy Center LLC
GAAmbulatory Surgical Clinic/CenterNPI 1912265653Tax ID 45-3369410
$967.00Published rate
Genesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
MIAmbulatory Surgical Clinic/CenterNPI 1396832549Tax ID 38-3242685
$750.00Published rate
Alderwood Surgery Center LLC
Alderwood Surgical Center
WAAmbulatory Surgical Clinic/CenterNPI 1386858595Tax ID 20-4979154
$469.00Published rate
Interventional Surgery Institute Of Little Rock, LLC, Interventional Surgery Institute
Interventional Surgery Institute Of Little Rock LLC
ARAmbulatory Surgical Clinic/CenterNPI 1043625221Tax ID 47-1050942
$298.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 11421 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 11421 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 11421 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
11420-CPT	Low	Exc H F Nk Sp B9 Marg 0 5, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Scalp Neck Hands Feet Genitalia Excised Diameter 0 5 Cm Or Less
11421-CPT	Low	Exc H F Nk Sp B9 Marg 0 6 1, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Scalp Neck Hands Feet Genitalia Excised Diameter 0 6 To 1 0 Cm
11422-CPT	Low	Exc H F Nk Sp B9 Marg 1 1 2, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Scalp Neck Hands Feet Genitalia Excised Diameter 1 1 To 2 0 Cm
11423-CPT	Moderate	Exc H F Nk Sp B9 Marg 2 1 3, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Scalp Neck Hands Feet Genitalia Excised Diameter 2 1 To 3 0 Cm

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11421. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 11421 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 11421 Fee Schedule

Compare published rates across providers.

Baycare Aurora Kaukauna Surgery Center LLC, Kaukauna Surgery Center

Braselton Endoscopy Center, LLC

Genesee Care L.L.C., The Surgery Center Of Genesee County

Alderwood Surgery Center LLC

Interventional Surgery Institute Of Little Rock, LLC, Interventional Surgery Institute