CPT 11622Surgery

Exc s/n/h/f/g mal+mrg 1.1-2

CPT 11622 covers the surgical removal of a malignant (cancerous) skin lesion measuring between 1.1 and 2.0 centimeters, including necessary margins around the tumor to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$245.51

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

2.41

PE RVU (NF)

4.9

MP RVU

0.28

Total RVU

7.59

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

NCCI bundling edits

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Billing tips

Measure the lesion plus the narrowest margin required for complete excision before closing—this total diameter determines code selection between 11621 (≤1.0 cm), 11622 (1.1-2.0 cm), and 11623 (2.1-3.0 cm)
Impact: Coding one size category too low (11621 vs 11622) results in $72 underpayment per Medicare non-facility rate; one category too high risks audit and recoupment
Verify anatomic site qualifies for 11620-11626 series (scalp, neck, hands, feet, genitalia); trunk/extremity excisions use 11600-11606 series with different reimbursement rates
Impact: Wrong anatomic code family can result in $40-80 payment differential and potential downcoding or denial
Document malignancy confirmation method (prior biopsy with pathology report number, or excision as biopsy with intent to treat) to justify malignant vs. benign code selection
Impact: Malignant excisions (11622) reimburse approximately $80-120 more than benign codes (11422) due to higher complexity and margin requirements
For facility billing, use facility rate ($164.97) and ensure procedure room/OR time is separately captured; physicians bill globally in non-facility settings ($245.51)
Impact: Site-of-service errors cause $80.54 payment discrepancy between facility and non-facility rates for this code
When billing multiple excisions same session, list largest/most complex first without modifier, append modifier 51 or 59 to subsequent codes per payer policy
Impact: Proper sequencing maximizes reimbursement; secondary procedures typically paid at 50%, saving the highest-paying code from reduction preserves $80-120 per claim
Correlate operative note measurements with final pathology report dimensions; significant discrepancies trigger audits and may require modifier 22 for unusual complexity

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11622 in 2025?

Medicare pays $245.51 for CPT 11622 in non-facility settings (physician office) and $164.97 in facility settings (hospital outpatient or ASC) based on the 2025 national average rates. Actual payment may vary by geographic locality based on GPCI adjustments.

How do you measure lesion size for CPT 11622 coding?

Measure the greatest clinical diameter of the lesion plus the narrowest margins required for complete excision before closing the wound. The total excised diameter must fall between 1.1 and 2.0 cm to correctly code 11622. Document measurements in the operative note in centimeters.

What is the difference between CPT 11622 and 11422?

CPT 11622 is for excision of malignant (cancerous) lesions sized 1.1-2.0 cm on scalp/neck/hands/feet/genitalia, while 11422 is for benign (non-cancerous) lesions of the same size and locations. Malignant codes require pathology confirmation and reimburse at higher rates due to increased complexity and margin requirements.

Can CPT 11622 be billed with an office visit on the same day?

Yes, but only if the E/M service is significant and separately identifiable from the pre-procedure assessment. Append modifier 25 to the E/M code and document a distinct service (addressing unrelated problem or exceeding routine surgical decision-making). Most same-day-of-surgery E/M visits are bundled unless separately justified.

What anatomic locations qualify for CPT 11622?

CPT 11622 applies only to lesions on the scalp, neck, hands, feet, or genitalia. Excisions from the trunk, arms, or legs use different code series (11600-11606) even if the lesion size is identical. Incorrect anatomic coding results in denials or payment differences.

How many RVUs is CPT code 11622 worth?

CPT 11622 has 7.59 total RVUs for 2025: 2.41 work RVUs, 4.9 non-facility practice expense RVUs (2.41 facility PE RVUs), and 0.28 malpractice RVUs. These are multiplied by the conversion factor of 32.3465 to determine Medicare payment rates.

What happens if pathology shows the lesion was actually benign after billing 11622?

If you coded 11622 (malignant) but final pathology reveals benign pathology, you should submit a corrected claim with the appropriate benign code (11422) to avoid audit risk. Some payers accept clinical suspicion to justify malignant codes, but others require pathologic confirmation. Check payer LCD policies and maintain documentation of pre-excision clinical assessment supporting treatment as malignant.