CPT 11603Surgery

Exc tr-ext mal+marg 2.1-3 cm

CPT code 11603 covers the surgical removal of a cancerous skin growth (with margins) measuring 2.1 to 3.0 centimeters on the trunk, arms, or legs. This includes cutting out the tumor plus surrounding healthy tissue to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$271.06

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

2.82

PE RVU (NF)

5.22

MP RVU

0.34

Total RVU

8.38

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

NCCI bundling edits

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Billing tips

Measure the excised diameter (lesion plus margins), not just the lesion size. Document pre-excision measurement and include margins in total measurement to select correct code.
Impact: Incorrect measurement can lead to downcoding from 11603 ($271.06) to 11602 (~$230) or upcoding denials if 11604 billed inappropriately
Bill in non-facility setting when possible. The practice receives $271.06 versus $188.26 in facility setting.
Impact: $82.80 higher reimbursement per procedure in office/clinic versus hospital outpatient department
Document medical necessity clearly: include clinical description, suspicion of malignancy, prior biopsy results, or clinical features requiring excision with margins.
Impact: Prevents medical necessity denials which result in $0 payment; appeals are successful only 30-40% of the time
Use anatomic location modifiers (LT/RT) and modifier 59 appropriately when billing multiple excisions to prevent bundling.
Impact: Prevents automatic denials of secondary procedures; can preserve $188-$271 per additional excision
Do not unbundle complex closure or intermediate closure with this code if closure is performed. Bill appropriate closure code separately (12031-12057 for intermediate, 13100-13153 for complex).
Impact: Simple closure is included in 11603; intermediate closure adds $150-$350, complex closure adds $300-$600 depending on length
Verify pathology confirms malignancy for audit protection. If pathology returns benign, be prepared to appeal with documentation of clinical suspicion at time of excision.
Post-payment audits may recoup payment if benign pathology found without documented clinical justification; represents 100% payment clawback risk

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Frequently asked questions

What is the Medicare reimbursement for CPT 11603 in 2025?

Medicare pays $271.06 for CPT 11603 in non-facility settings and $188.26 in facility settings based on the 2025 Physician Fee Schedule. The non-facility rate applies when performed in an office or clinic, while the facility rate applies in hospital outpatient departments or ambulatory surgery centers.

How do you measure lesion size for CPT 11603?

Measure the excised diameter, which includes both the lesion itself and the margins removed around it. For 11603, the total excised diameter must be 2.1 to 3.0 cm. Document the measurement before excision and include it in the operative note. The lesion alone may be smaller, but margins must be included in total measurement.

Can you bill CPT 11603 with an E/M code on the same day?

Yes, you can bill an E/M code with modifier 25 on the same day as 11603 if a significant, separately identifiable evaluation and management service is performed. The E/M must be beyond the usual pre-operative assessment and documented separately, such as a new patient consultation or evaluation of unrelated conditions.

What is the difference between CPT 11603 and 11606?

CPT 11603 is for excision of malignant lesions on the trunk or extremities (arms, legs, hands, feet) measuring 2.1-3.0 cm, while 11606 is for malignant lesions on the face, ears, eyelids, nose, lips, or mucous membranes of the same size. The anatomic location determines which code to use; facial/head lesions generally have higher reimbursement.

How many RVUs is CPT code 11603 worth in 2025?

CPT 11603 has 8.38 total RVUs in 2025, consisting of 2.82 work RVUs, 5.22 non-facility practice expense RVUs (2.66 facility PE RVUs), and 0.34 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of 32.3465 determine Medicare payment rates.

What happens if pathology shows the lesion is benign after billing 11603?

If pathology returns benign but you had clinical suspicion of malignancy documented before excision, the 11603 code may still be appropriate. Document clinical features suggesting malignancy (irregular borders, rapid growth, patient concern, atypical appearance). If audited, provide pre-excision notes justifying clinical decision. Some payers may require recoding to benign excision codes (11423 for same size).

Can you bill multiple units of CPT 11603 for multiple lesions?

Yes, bill separate lines for each distinct lesion excised, applying modifier 51 to subsequent procedures and modifier 59 if needed to indicate separate sites. Use anatomic modifiers (LT/RT) for laterality. The second and additional procedures are typically reimbursed at 50% of the base rate ($135.53 for non-facility). Document each lesion's location, size, and separate excision clearly.