CPT 11600Surgery

Exc tr-ext mal+marg 0.5 cm/<

CPT 11600 covers the surgical removal of a small malignant (cancerous) skin lesion on the trunk, arms, or legs, where the lesion is 0.5 centimeters or smaller, including margins (the healthy tissue removed around it).

Showing rates for

National Average

Base Medicare rate

$191.17

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

1.63

PE RVU (NF)

4.07

MP RVU

0.21

Total RVU

5.91

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

NCCI bundling edits

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Billing tips

Measure the excised diameter including margins, not the visible lesion size—this is the clinical measurement before excision, including the intended margins
Impact: Incorrect measurement selection between 11600 (≤0.5cm) and 11601 (0.6-1.0cm) results in $43-68 underpayment per lesion
Verify anatomic location carefully; face/neck/hands/feet codes (11640 series) reimburse approximately 25-40% higher than 11600 trunk/extremity codes
Impact: Miscoding a hand lesion as 11600 instead of 11640 costs $57.23 in non-facility setting ($248.40 vs $191.17)
Document pathology confirmation of malignancy either pre-operatively (prior biopsy) or post-operatively; excision of 'suspected' malignancy without confirmation may be downcoded to benign lesion codes (11400 series)
Impact: Downcoding from 11600 to 11400 results in $65.59 loss ($191.17 vs $125.58 non-facility rate)
When excising multiple lesions in same session, list largest/most complex excision first without modifier 51, then append 51 to subsequent codes
Impact: Proper sequencing maximizes reimbursement; incorrect sequencing can reduce total payment by 5-10% across multiple excisions
Bill facility vs non-facility based on actual site of service; ASC and HOPD use facility rate, while office-based procedures use non-facility rate
Impact: $71.81 difference between non-facility ($191.17) and facility ($119.36); incorrect POS code triggers recoupment
Intermediate or complex closures are separately billable (12031-12057, 13100-13153); do not include in 11600 if performed
Failing to separately code complex closure loses $150-400 in additional legitimate reimbursement per repair

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11600 in 2025?

The 2025 Medicare national average reimbursement for CPT 11600 is $191.17 in non-facility settings (physician office) and $119.36 in facility settings (hospital outpatient or ASC). Actual rates vary by geographic locality based on GPCI adjustments.

How do you measure lesion size for CPT 11600 coding?

Measure the excised diameter including margins, not just the visible lesion. This is the clinical measurement taken before excision, encompassing the lesion plus the margin of normal tissue planned for removal. For 11600, the total excised diameter must be 0.5 cm or less. If the excised diameter is 0.6-1.0 cm, use 11601 instead.

Can you bill an E/M visit with CPT 11600 on the same day?

Yes, but only if the E/M service is significant and separately identifiable from the surgical pre-operative assessment, and you append modifier 25 to the E/M code. The E/M must address issues beyond the decision for surgery or represent evaluation of a separate problem. Documentation must clearly support the distinct service.

What is the difference between CPT 11600 and 11400?

CPT 11600 is for excision of malignant lesions (confirmed cancer such as melanoma, basal cell carcinoma, squamous cell carcinoma), while 11400 is for benign lesions (non-cancerous). The codes also differ by anatomic site. Coding is based on final pathology diagnosis, and 11600 reimburses significantly higher ($191.17 vs $125.58 non-facility).

How many RVUs is CPT code 11600 worth?

CPT 11600 has a total of 5.91 RVUs in 2025, consisting of 1.63 work RVUs, 4.07 non-facility practice expense RVUs (1.85 facility PE RVUs), and 0.21 malpractice RVUs. These are multiplied by the 2025 conversion factor of 32.3465 to determine payment.

Can you bill multiple 11600 codes for multiple lesions?

Yes, you can bill 11600 multiple times when excising multiple malignant lesions in the same session. List the first lesion without a modifier, then append modifier 51 (or 59/XS if appropriate) to subsequent excisions. Most payers reduce payment by 50% for the second and subsequent lesions. Ensure each lesion is documented separately with individual measurements and locations.

Is closure included in CPT 11600 or billed separately?

Simple (single-layer) closure is included in CPT 11600 and cannot be billed separately. However, intermediate closure (layered closure) or complex closure (requiring undermining, extensive cleaning, or complex techniques) can be billed separately using codes 12031-12057 or 13100-13153, depending on location and length.