CPT 11446Surgery

Exc face-mm b9+marg >4 cm

CPT code 11446 covers the surgical removal of a benign (non-cancerous) skin growth on the face, ears, eyelids, nose, lips, or mucous membranes that is larger than 4 centimeters (about 1.6 inches), including the margins around it.

Showing rates for

National Average

Base Medicare rate

$376.51

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

4.8

PE RVU (NF)

6.15

MP RVU

0.69

Total RVU

11.64

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

NCCI bundling edits

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Billing tips

Measure and document excised diameter (lesion plus margins), not just the visible lesion size. The excised diameter determines code selection and must exceed 4.0 cm for 11446.
Impact: Underdocumentation can result in downcoding to 11444 (3.1-4.0 cm, $281.30) causing a loss of $95.21 per claim (25% revenue reduction)
Bill intermediate (12051-12057) or complex repairs (13151-13153) separately when closure requires layered closure or extensive undermining beyond simple closure.
Impact: Can add $200-800+ per procedure depending on repair complexity; simple closure is included in 11446 but documented complex closures warrant separate codes
Verify pathology confirms benign diagnosis post-procedure. If pathology reveals malignancy, consider filing a corrected claim with appropriate malignant lesion code (11646).
Impact: Code 11646 (malignant >4cm) reimburses at $501.84 non-facility, a difference of $125.33 (33% increase) compared to benign code
Document medical necessity clearly, especially for large cosmetic lesions. Include functional impairment, trauma risk, or diagnostic uncertainty to support medical necessity.
Impact: Prevents denials for cosmetic procedures which are typically non-covered; medical necessity documentation prevents denial of entire $376.51 claim
Use appropriate place of service code: POS 11 (office) receives non-facility rate ($376.51) while POS 22 (ASC) or 24 (ASC) receives facility rate ($312.14).
Impact: Correct POS selection ensures proper rate; office-based procedures yield $64.37 more per procedure (17% higher reimbursement)
When multiple lesions are excised in same session, list largest/most complex lesion first without modifier 51, then append modifier 51 to subsequent procedures in descending RVU order.

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11446 in 2025?

Medicare pays $376.51 for CPT 11446 in non-facility settings (office) and $312.14 in facility settings (ASC/hospital outpatient) based on the 2025 Physician Fee Schedule. These are national averages; actual payment may vary by locality based on geographic adjustment factors.

What size lesion qualifies for CPT code 11446?

CPT 11446 requires the excised diameter (lesion plus margins) to exceed 4.0 cm. This measurement includes both the visible lesion and the surgical margins removed around it. If the excised diameter is 4.0 cm or less, a lower code (11444 or below) must be used.

Can I bill a repair code separately with CPT 11446?

Simple closure is included in CPT 11446 and cannot be billed separately. However, intermediate closures (12051-12057) or complex repairs (13151-13153) requiring layered closure or extensive undermining may be billed separately with appropriate documentation of the additional work performed.

What is the global period for CPT 11446?

CPT 11446 has a 90-day global surgical period. This means routine postoperative care for 90 days after the procedure is included in the reimbursement and cannot be billed separately unless complications occur or unrelated services are provided with modifier 79.

What diagnosis codes support medical necessity for CPT 11446?

Appropriate ICD-10 codes include benign neoplasm codes (D23.x for face), nevus codes (D22.x), lipoma (D17.x), seborrheic keratosis (L82.x), and other benign lesion codes. Documentation should support medical necessity beyond cosmetic concerns, such as functional impairment, trauma risk, or diagnostic uncertainty.

How do I bill multiple lesion excisions with CPT 11446?

List the largest or most complex excision first without modifier 51, then list additional excisions in descending RVU order with modifier 51 appended. The first procedure receives 100% payment ($376.51) while additional procedures typically receive 50% payment. Each lesion must meet the size criteria for its respective code.

What if pathology shows the lesion was malignant after I billed 11446?

If final pathology reveals malignancy, you should file a corrected claim using CPT 11646 (excision malignant lesion face >4cm), which reimburses at $501.84 non-facility rate. Include the pathology report with the corrected claim and note that pre-operative clinical assessment indicated benign appearance but final diagnosis was malignant.