CPT 11620Surgery

Exc h-f-nk-sp mal+marg 0.5/<

CPT code 11620 covers the surgical removal of a small malignant (cancerous) skin lesion from the face, ears, eyelids, nose, lips, or mucous membranes, where the lesion is 0.5 centimeters or smaller, including margins.

Showing rates for

National Average

Base Medicare rate

$191.81

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

1.64

PE RVU (NF)

4.07

MP RVU

0.22

Total RVU

5.93

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

NCCI bundling edits

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Billing tips

Always confirm malignancy via pathology before billing 11620; if pathology reveals benign lesion, you must bill benign excision code (11440) instead
Impact: Billing 11620 for benign lesions constitutes miscoding and may result in recoupment of $50-70 per case plus potential fraud investigation
Measure and document excised diameter including margins, not just the visible lesion; 11620 covers ≤0.5cm excised diameter
Impact: Upcoding to 11621 (0.6-1.0cm, pays $238.27) without proper measurement documentation will trigger audit and recoupment
Bill in non-facility setting when performed in office to capture $191.81 vs $120.33 facility rate—a $71.48 difference per procedure
Impact: For practices performing 200 facial malignant excisions annually, choosing appropriate setting yields $14,296 additional revenue
When multiple lesions are excised, list largest/most complex first without modifier 51, then append modifier 51 to subsequent procedures
Impact: Proper sequencing maximizes reimbursement; reversing order can cost 25-30% of potential payment on secondary procedures
Link appropriate malignancy diagnosis code (C44.x for skin cancer of specific site) with site matching CPT descriptor (H-F-Nk-Sp)
Impact: Mismatched diagnosis (e.g., trunk lesion C44.5 with facial excision code) triggers automatic denial requiring appeals and 30-60 day payment delay
Document whether closure was simple, intermediate, or complex; complex closure requires separate billing (13151-13153) and significantly increases reimbursement
Missing complex closure code (pays additional $300-600) represents substantial lost revenue if layered closure or extensive undermining performed

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Frequently asked questions

What is the CPT code 11620 used for?

CPT 11620 is used for excision of a malignant skin lesion (cancer) measuring 0.5 cm or less in excised diameter including margins, located on the head, face, neck, hands, feet, or genitalia. This includes removal of the cancerous tissue plus surrounding margin and simple or intermediate closure.

How much does Medicare pay for CPT 11620 in 2025?

Medicare pays $191.81 for CPT 11620 when performed in a non-facility setting (office) and $120.33 when performed in a facility setting (hospital or ASC) based on the 2025 national average rates. Actual payment may vary by geographic location due to locality adjustments.

What is the difference between CPT 11620 and 11621?

The difference is the size of the excised lesion including margins: CPT 11620 covers malignant lesions 0.5 cm or smaller, while CPT 11621 covers lesions 0.6 cm to 1.0 cm. Both are for the same anatomical areas (head, face, neck, hands, feet, genitalia) and both are for malignant lesions.

Can I bill an E/M code with CPT 11620 on the same day?

Yes, you can bill an E/M service with CPT 11620 on the same day if the E/M represents a separately identifiable service beyond the decision for surgery, such as evaluation of other conditions or a comprehensive skin examination. You must append modifier 25 to the E/M code and document the separate service clearly.

How do I measure the lesion size for CPT 11620?

Measure the excised diameter including the clinical margins, not just the visible lesion size. For example, if the lesion is 0.2 cm and you take 2mm margins on all sides, the excised diameter is approximately 0.6 cm, which would require CPT 11621, not 11620. Always document the measured excised specimen diameter in your operative note.

What diagnosis codes are appropriate for CPT 11620?

Use site-specific malignant neoplasm codes from the C44.x series (malignant neoplasm of skin). Examples include C44.319 (skin of nose), C44.309 (skin of face unspecified), C44.40 (skin of scalp/neck), C44.60 (skin of upper limb), C44.70 (skin of lower limb), or C44.9 (skin of external genitalia). The diagnosis must match the anatomical site described in your documentation.

Does CPT 11620 include the pathology examination?

No, CPT 11620 does not include pathology services. The surgical pathology examination should be billed separately using CPT 88305 (level IV surgical pathology, gross and microscopic examination) for skin excisions. The pathology confirms malignancy and margin status, which is essential for proper coding and patient care.