Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57113 (Billing and Coding: Removal of Benign Skin Lesions) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57113: Billing and Coding: Removal of Benign Skin Lesions (Billing and Coding, effective 2026-01-01)
- Covered ICD-10-CM codes
- 242
- 8 groups
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 51
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A54.02 | — |
| A54.1 | — |
| A63.0 | — |
| B07.0 | — |
| B07.8 | — |
| B08.1 | — |
| C44.00 | — |
| C44.01 | — |
| C44.02 | — |
| C44.09 | — |
| C44.1021 | — |
| C44.1022 | — |
| C44.1091 | — |
| C44.1092 | — |
| C44.1121 | — |
| C44.1122 | — |
| C44.1191 | — |
| C44.1192 | — |
| C44.1221 | — |
| C44.1222 | — |
| C44.1291 | — |
| C44.1292 | — |
| C44.1921 | — |
| C44.1922 | — |
Procedure codes: 11200, 11201, 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, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111 and 11 more in the article.
Coverage indications, limitations and medical necessity
Notice : Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
Benign lesions may be removed in a variety of ways. These methods can be grouped into one of the following three categories.
• Shaving of Epidermal or Dermal Lesions
• Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization. The wound does not require suture closure.
• Excision - Benign Lesions
• Excision of benign lesions of skin includes local anesthesia. Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed.
• Destruction, Benign Lesions
• Destruction means the ablation of benign tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure.
• Medical record documentation must support medical necessity for excisional removal of a benign skin lesion for other than cosmetic purposes. Each benign lesion excised should be reported separately.
Covered Indications
In selected circumstances, the removal of lesions (e.g., seborrheic keratoses, epidermoid cysts, moles [nevi], acquired hyperkeratosis, molluscum contagiosum, milia, viral warts, benign neoplasms, hemangiomas, lipomas, and pyogenic granulomas) is medically appropriate. Therefore, Medicare will consider their removal as medically necessary, and not cosmetic, if one or more of the following conditions are present and clearly documented in the medical record:
• The lesion has become symptomatic or has undergone a change in appearance or displays evidence of inflammation or infection.
• The lesion obstructs an orifice.
• The lesion clinically restricts eye function. For example, the lesion
• restricts eyelid function
• causes misdirection of eyelashes or eyelid
• restricts lacrimal puncta and interferes with tear flow
• touches the globe
• interferes with vision
• There is clinical uncertainty as to the likely diagnosis, particularly where malignancy is a realistic consideration based on lesion appearance or prior biopsy of a related or similar lesion suggesting malignancy.
• A prior histological exam or biopsy suggests or is indicative of atypia (e.g., atypical nevus) or malignancy.
• The lesion is in an anatomical region subject to recurrent physical trauma and there is documentation that such trauma has occurred.
• Removal of molluscum contagiosum.
• Benign epidermal or pilar cyst with history of infection, drainage, or rupture.
• Wart removals will be covered under guidelines above. In addition, wart destruction will be covered when any of the following clinical circumstances are present:
• Periocular warts associated with chronic recurrent conjunctivitis thought to be secondary to lesion virus shedding
• Warts showing evidence of spread from one body area to another
• Lesions are condyloma acuminate
• Please refer to the National Coverage Determination (NCD) 250.4 for coverage details regarding Actinic Keratosis.
Limitations
The following are considered not reasonable and necessary and therefore will be denied:
• Please refer to CMS IOM Publication 100-04, Medicare Claims Processing Manual , Chapter 12, Section 30.6.6 for instructions regarding Evaluation and Management (E/M) services during the global period of surgery and on the same day as a procedure.
• Removal of certain benign skin lesions that do not pose a threat to health or function is considered cosmetic, and as such, is not covered by the Medicare program. If the beneficiary wishes to have one or more of these benign asymptomatic lesions removed for cosmetic purposes, the beneficiary becomes liable for the service rendered. The provider has the responsibility to notify the patient in advance that Medicare will not cover that cosmetic procedure and the beneficiary will be liable for the cost of the service.
• Lesions in sensitive anatomical locations that are not creating problems do not qualify for removal coverage on the basis of location alone.
Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in this LCD.
Summary of evidence (opening)
N/A
The contractor cites 3 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2019-09-26
- Last reviewed by the contractor
- 2018-01-29
- MCD version
- 68
- Derived from
- L27527
The contractor lists one National Coverage Determination as related: NCD 250.4 Treatment of Actinic Keratosis. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Novitas Solutions, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L34938 cover?
Notice : Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34938 apply to?
Novitas Solutions, Inc. applies it to Medicare claims in AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34938?
The companion billing and coding article A57113 lists 242 ICD-10-CM codes in 8 groups that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34938?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.