CPT 11443Surgery

Exc face-mm b9+marg 2.1-3 cm

CPT code 11443 is used when a surgeon removes a benign (non-cancerous) growth or lesion from the face, including the area around the eyes, nose, lips, or ears, when the removed tissue plus margins measures between 2.1 and 3.0 centimeters.

Showing rates for

National Average

Base Medicare rate

$222.54

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

2.34

PE RVU (NF)

4.21

MP RVU

0.33

Total RVU

6.88

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

NCCI bundling edits

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Billing tips

Measure the lesion plus margins before excision and document the greatest clinical diameter in the operative note; this pre-excision measurement determines code selection, not the pathology specimen size
Impact: Proper measurement documentation prevents downcoding from 11443 to 11442, protecting approximately $46 per procedure in non-facility settings
Bill in the non-facility setting when performed in office-based surgical suites to capture the higher rate of $222.54 versus $176.29 facility rate
Impact: Increases reimbursement by $46.25 (26% higher) when appropriately performed in qualifying non-facility settings
For multiple lesions excised in the same session, list the largest/most complex excision first without modifier 51, then apply modifier 51 to subsequent excisions in descending order of complexity
Impact: Maximizes reimbursement by ensuring the highest-paying procedure receives 100% payment; improper sequencing can reduce total payment by 10-15%
Document anatomic location with specificity (e.g., 'left nasal ala' not just 'nose') to support medical necessity and justify facial code selection over lower-paying trunk/extremity codes
Impact: Facial excision codes (114xx series) reimburse 40-60% higher than trunk codes (116xx series); 11443 pays $222.54 vs 11603 which pays approximately $165
When layered closure is performed, resist the temptation to separately bill intermediate/complex repair codes (12xxx series); simple closure is included in the excision code
Impact: Prevents denials and recoupment; separately billing repair codes with excision codes is considered unbundling and can trigger audits

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 11443?

For 2025, Medicare pays $222.54 for CPT 11443 in the non-facility (office) setting and $176.29 in the facility setting under the national average. The code has a total of 6.88 RVUs (2.34 work RVU, 4.21 non-facility PE RVU, 2.78 facility PE RVU, and 0.33 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How do I determine if I should use CPT 11442, 11443, or 11444?

Code selection depends on the excised diameter (lesion plus margins) measured before excision: use 11442 for 1.1 to 2.0 cm, 11443 for 2.1 to 3.0 cm, and 11444 for 3.1 to 4.0 cm. Always measure the greatest clinical diameter including the margins you plan to excise, not the lesion size alone or the pathology specimen size.

Can I bill an E/M visit with CPT 11443 on the same day?

Yes, but only if the E/M service is separately identifiable from the decision for surgery and you append modifier 25 to the E/M code. If the visit was solely to perform a pre-planned excision with no significant separate evaluation, only the procedure code 11443 should be billed. Document the distinct E/M service clearly in the medical record.

Is closure included in CPT 11443 or can I bill it separately?

Simple closure (single layer) is included in CPT 11443 and cannot be billed separately. Intermediate or complex layered closure is also included in facial excision codes per CPT guidelines. Do not separately report repair codes (12xxx-13xxx series) with benign facial excision codes, as this constitutes unbundling.

What is the global period for CPT 11443?

CPT 11443 has a 10-day global period. This means routine postoperative care for 10 days following the procedure is included in the payment, and separately billing E/M services for normal postoperative care during this period is not appropriate unless unrelated to the excision or complications require additional services beyond routine care.

Does CPT 11443 require pathology to be performed?

No, pathology is not required to bill CPT 11443, but the provider must have documented clinical certainty that the lesion is benign. If pathology is performed, the dermatopathology code (88305 for most excisions) is separately billable. If clinical diagnosis alone is used without pathology, document the clinical characteristics supporting the benign diagnosis clearly.

How should I bill multiple facial lesion excisions in the same session?

List each excision separately with its appropriate size-based code. Report the largest or most complex excision first at 100% payment, then apply modifier 51 to subsequent excisions which will typically receive 50% payment. Do not combine measurements of separate lesions; each lesion with its margins is coded individually based on its own excised diameter.