CPT 11442Surgery

Exc face-mm b9+marg 1.1-2 cm

CPT 11442 covers the surgical removal of a benign (non-cancerous) skin lesion from the face, ears, eyelids, nose, lips, or mucous membranes, measuring between 1.1 and 2.0 centimeters including margins. The procedure includes local anesthesia, excision, and simple closure.

Showing rates for

National Average

Base Medicare rate

$187.93

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.77

PE RVU (NF)

3.81

MP RVU

0.23

Total RVU

5.81

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document total excised diameter including margins, not just the lesion size. A 0.9 cm lesion with 0.3 cm margins qualifies for 11442, not 11441.
Impact: Proper measurement documentation justifies 11442 ($187.93) versus 11441 ($139.89), a difference of $48.04 per procedure
Pathology confirmation of benign nature is not required before billing but should be obtained post-excision. If pathology reveals malignancy, file corrected claim with appropriate malignant excision code (11642-11646).
Impact: Malignant codes reimburse $250-400+ versus $187.93 for benign; proactive correction within claim filing deadline maximizes appropriate revenue
Bill facility (ASC/HOPD) cases with understanding that Medicare pays only $144.59 versus $187.93 in office; verify facility fee capture separately.
Impact: $43.34 difference in physician payment between settings; total facility reimbursement may exceed $1,500 when combining professional and technical components
When excising multiple lesions in same session, list largest/most complex as primary procedure without modifier 51, then append modifier 51 to subsequent codes to ensure proper payment hierarchy.
Impact: Prevents incorrect payment reduction on highest-valued procedure; can preserve $50-100 in reimbursement per session
Verify whether closure is simple (included) or intermediate/complex (separately billable with 12051-12057). Layered closure of facial excisions often qualifies as intermediate repair.
Impact: Intermediate repair codes add $150-350 to total reimbursement; commonly missed revenue opportunity on facial excisions
For cosmetic excisions, obtain advance beneficiary notice (ABN) or patient waiver before service. Medicare excludes purely cosmetic procedures from coverage.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11442 in 2025?

Medicare pays $187.93 for CPT 11442 in non-facility settings (office) and $144.59 in facility settings (ASC/HOPD) based on the 2025 Physician Fee Schedule national average. Actual rates vary by geographic locality and MAC region.

How do I measure the excised diameter for CPT 11442 coding?

Measure the total excised diameter including the lesion PLUS all margins removed. For 11442, the total must be 1.1 to 2.0 cm. Example: a 0.8 cm lesion with 0.4 cm margins on all sides = 1.6 cm total excised diameter, qualifying for 11442. Document this measurement explicitly in the operative note.

Can I bill an E/M visit with CPT 11442 on the same day?

Yes, but only if a separately identifiable evaluation and management service is performed and documented. Append modifier 25 to the E/M code. The E/M must involve evaluation beyond the decision to perform the excision, such as assessment of multiple lesions, other conditions, or significant pre-procedure medical decision-making.

What is the difference between CPT 11442 and 11642?

CPT 11442 is for benign lesion excision (1.1-2.0 cm) while 11642 is for malignant lesion excision (same size range, same anatomic area). Use 11442 when clinical appearance suggests benign nature; if pathology later confirms malignancy, file a corrected claim with 11642. Malignant codes reimburse significantly higher.

Does CPT 11442 include the closure of the wound?

Yes, 11442 includes simple (single layer) closure. However, if intermediate (layered closure of one or more deeper layers) or complex closure is required, you may separately bill repair codes 12051-12057 for facial closures. This commonly applies to facial excisions requiring cosmetic layered closure and can add $150-350 to reimbursement.

How many RVUs is CPT code 11442 worth in 2025?

CPT 11442 has 5.81 total RVUs in 2025, broken down as: 1.77 work RVUs, 3.81 non-facility practice expense RVUs (2.47 facility PE RVUs), and 0.23 malpractice RVUs. These are multiplied by the conversion factor of 32.3465 to determine Medicare payment.

What are common denial reasons for CPT 11442 and how can I prevent them?

Common denials include: (1) medical necessity challenges when lesions appear cosmetic - prevent by documenting symptoms like bleeding, irritation, or growth; (2) downcoding due to size documentation - prevent by explicitly stating 'total excised diameter with margins: X.X cm'; (3) bundling with E/M - prevent by using modifier 25 and documenting separate service; (4) global period issues - prevent by using modifiers 58/79 appropriately.