CPT 11606Surgery

Exc tr-ext mal+marg >4 cm

CPT code 11606 is used when a surgeon removes a malignant (cancerous) skin lesion larger than 4 cm from the trunk, arms, or legs, including a margin of healthy tissue around it. This is a complex excision requiring significant tissue removal and often layered closure.

Showing rates for

National Average

Base Medicare rate

$436.03

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

5.02

PE RVU (NF)

7.61

MP RVU

0.85

Total RVU

13.48

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Measure and document the excised diameter, not the lesion diameter alone. Include margins in the total measurement (lesion plus margins removed equals excised diameter).
Impact: Difference between 11606 ($436.03) and 11604 for 3.1-4.0 cm ($334.91) = $101.12 per case. Underdocumentation costs ~$100 per case.
Report intermediate or complex closure separately with appropriate repair codes (12031-13160) when closure exceeds simple closure complexity. Simple closure is bundled.
Impact: Intermediate closures for large defects can add $150-400 to total reimbursement; document layered closure explicitly
For multiple excisions on same day, code each separately but expect modifier 51 reduction (50%) on secondary procedures. Rank codes by RVU value to maximize reimbursement.
Impact: Proper sequencing ensures highest-paying procedure gets 100% payment; can affect total payment by 10-15% when multiple excisions performed
Verify malignancy status is documented. Use 11606 for clinically malignant lesions even if pathology is pending; if final pathology shows benign, file corrected claim with appropriate benign excision code.
Impact: Malignant excision codes pay 30-50% more than benign codes; incorrect coding can result in $100-200 underpayment or overpayment
Bill facility vs. non-facility based on actual site of service. ASC and hospital outpatient use facility rate ($307.29), while office-based uses non-facility rate ($436.03).
Impact: Site of service differential = $128.74 per case; ensure POS code matches actual location to avoid recoupment
When re-excision is needed for positive margins, append modifier 78 if within global period and document medical necessity. Consider whether this represents a staged procedure (58) or complication (78).

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 11606?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement for CPT 11606 in 2025?

The 2025 Medicare national average reimbursement for CPT 11606 is $436.03 in non-facility settings (office-based) and $307.29 in facility settings (hospital outpatient or ASC). Actual payment varies by geographic locality and MAC.

How do you measure lesion size for CPT 11606?

For CPT 11606, measure the total excised diameter, which includes the lesion PLUS the margins removed on all sides. The total excised diameter must exceed 4.0 cm. Do not measure just the visible lesion; include the clinically normal tissue margins removed around it. Document this measurement in the operative report.

Can I bill closure codes separately with CPT 11606?

Simple closure is bundled into CPT 11606 and cannot be billed separately. However, intermediate closure (12031-12057) or complex closure (13100-13160) can be reported separately when the closure meets the CPT definition for those more complex repair types, typically requiring layered closure or extensive undermining.

What is the difference between CPT 11606 and 11606?

CPT 11606 specifically requires the excised diameter to exceed 4.0 cm. The related codes in this family are 11600 (0.5 cm or less), 11601 (0.6-1.0 cm), 11602 (1.1-2.0 cm), 11603 (2.1-3.0 cm), and 11604 (3.1-4.0 cm). Each represents progressively larger excisions with correspondingly higher reimbursement.

How many RVUs is CPT code 11606 worth?

CPT 11606 has a total of 13.48 RVUs in 2025, consisting of 5.02 work RVUs, 7.61 non-facility practice expense RVUs (3.63 facility PE RVUs), and 0.85 malpractice RVUs. This is among the higher-valued excision codes due to the size and complexity.

Does CPT 11606 require a prior biopsy showing malignancy?

No, prior biopsy is not required. CPT 11606 can be used when the provider has a clinical suspicion or diagnosis of malignancy and treats it as such. However, documentation must support the clinical reasoning for treating as malignant. If final pathology shows benign, a corrected claim with the appropriate benign excision code should be submitted.

What is the global period for CPT 11606?

CPT 11606 has a 90-day global surgical period. This means routine postoperative care for 90 days after the procedure is included in the reimbursement, and related E/M services during this period typically cannot be billed separately unless unrelated to the surgery or a complication occurs requiring return to the OR (modifier 78) or unrelated service (modifier 24).