CPT 11602Surgery

Exc tr-ext mal+marg 1.1-2 cm

CPT 11602 covers surgical removal of a cancerous skin growth (including margins) measuring 1.1 to 2.0 centimeters on the trunk, arms, legs, hands, or feet. This includes cutting out the malignant lesion plus a rim of normal tissue around it to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$237.75

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

2.27

PE RVU (NF)

4.83

MP RVU

0.25

Total RVU

7.35

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

NCCI bundling edits

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Billing tips

Measure and document the excised diameter (lesion plus margins), not just the visible lesion size, as this determines correct CPT code selection between 11600-11606
Impact: Incorrect measurement can result in $80-$120 underpayment if 11602 should be 11603, or trigger audit if overcoded from 11601
Confirm anatomic location qualifies as trunk/extremity; face, ears, eyelids, nose, lips require different code family (116xx series vs 114xx series)
Impact: Wrong anatomic code family can cause automatic denials requiring resubmission and 30-60 day payment delays
Ensure pathology report confirms malignancy before final claim submission; if benign on final path, recode to 11400-11406 series
Impact: Billing malignant excision for benign lesion is considered upcoding; can trigger recoupment of $100+ per claim plus audit risk
Bill each separately excised lesion individually when multiple lesions removed same session; use modifier 59 or XS for distinct lesions
Impact: Proper modifier use can capture $237.75 per lesion versus bundled single payment; improves revenue by $237.75 per additional lesion
Submit in facility setting (ASC/HOPD) to receive $157.53, or office setting for $237.75; verify place of service code matches actual location
Impact: Incorrect POS code can result in $80.22 payment differential and trigger payer audits for pattern discrepancies
Document margin width and reason for margin selection (standard 4mm, wider for melanoma, etc.) to support medical necessity and size coding
Impact: Missing margin documentation is primary audit trigger; can result in downcoding to intermediate repair codes with 40-60% payment reduction

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Frequently asked questions

What is the Medicare reimbursement for CPT 11602 in 2025?

Medicare pays $237.75 for CPT 11602 in non-facility settings (office) and $157.53 in facility settings (hospital outpatient or ASC) based on the 2025 national average. Actual payment may vary by geographic locality based on GPCI adjustments.

Does CPT 11602 include the closure of the excision site?

Yes, CPT 11602 includes simple (single-layer) closure. If intermediate closure (layered) or complex closure is performed, you may separately bill 12031-12057 for intermediate or 13100-13160 for complex repairs based on location and wound length.

How do I measure the lesion size for coding 11602 correctly?

Measure the excised diameter, which includes the visible lesion plus the margins removed around it. For 11602, this total measurement must be 1.1 to 2.0 cm. Do not code based on the lesion size alone; the complete excised specimen diameter determines the correct code.

Can I bill CPT 11602 for multiple lesions on the same day?

Yes, bill 11602 for each separately excised lesion that meets the size and location criteria. Append modifier 59 or XS to subsequent lesions to indicate distinct procedural services. The first lesion receives 100% payment ($237.75), while additional lesions may be subject to multiple procedure reduction depending on payer.

What is the difference between CPT 11602 and 11402?

CPT 11602 is for malignant lesion excision on trunk/extremities sized 1.1-2.0 cm (pays $237.75), while 11402 is for benign lesion excision on trunk/extremities sized 1.1-2.0 cm (pays significantly less). The distinction is based on pathology confirmation of malignancy versus benign pathology.

What RVU value does CPT 11602 have in 2025?

CPT 11602 has a total RVU of 7.35 in 2025, consisting of 2.27 work RVU, 4.83 non-facility practice expense RVU (2.35 facility PE RVU), and 0.25 malpractice RVU. These multiply by the 2025 conversion factor of 32.3465 to determine payment.

Does CPT 11602 require prior authorization from Medicare or commercial payers?

Medicare typically does not require prior authorization for CPT 11602, but commercial payers vary. Some payers may require authorization for office-based surgical procedures or may request pathology documentation. Always verify specific payer requirements before performing the procedure to avoid payment delays.