Lipoma Excision CPT® Codes & Reimbursement Strategies

Breaking Down Lipoma Excision CPT® Codes

Selecting the right code depends on location, depth, and size of the lipoma. Here are some examples:

Subcutaneous Lipomas (Above Fascia)

• Face/Scalp (≤2 cm) → 21011 (POS 11 allowed)

• Back/Flank (≥3 cm) → 21931 (POS 11 rarely allowed)

• Hand/Foot (≤1.5 cm) → 26115 or 28043 (POS 11 allowed)

Subfascial Lipomas (Below Fascia)

• Neck/Thorax (≥5 cm) → 21554 (POS 11 rarely allowed)

• Thigh/Knee (≥5 cm) → 27339 (POS 11 rarely allowed)

Avoiding Denials: Pro Tips

1. Check the Medicare Physician Fee Schedule Lookup Tool  (If the code has “NA” in the “non-facility fee” column, it may be denied if billed with POS 11). 

2. Verify Payer Policies—some commercial insurers follow Medicare, others have stricter rules.

3. Prior Authorization helps but doesn’t guarantee payment. Appeal with clinical justification if denied.

Key Takeaway

Misclassifying lipomas as cutaneous lesions risks audits, lost revenue and quality reporting.

Always:

• Document depth and size meticulously.

• Confirm POS eligibility before billing.

• Use pathology to support coding.

Need help? Compass audits ensure your coding maximizes compliance and reimbursement. Contact our team to schedule a meeting today.