CPT 11623Surgery

Exc s/n/h/f/g mal+mrg 2.1-3

CPT code 11623 is used when a physician surgically removes a cancerous skin growth (melanoma, basal cell carcinoma, squamous cell carcinoma) that measures between 2.1 and 3.0 centimeters, including a margin of healthy tissue around it.

Showing rates for

National Average

Base Medicare rate

$287.56

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

3.11

PE RVU (NF)

5.38

MP RVU

0.4

Total RVU

8.89

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 visible lesion size. The excised diameter determines code selection and must be documented in operative notes.
Impact: Undercoding from 11623 to 11622 (2.0 cm or less) reduces reimbursement by approximately $60-80 per procedure
Bill in the non-facility setting (office) when possible rather than HOPD to capture the $83.78 differential between settings.
Impact: Direct revenue increase of $83.78 per procedure when performed in-office versus hospital outpatient
When performing multiple excisions, sequence codes with highest RVU first (without modifier 51) and apply modifier 51 to subsequent codes to maximize reimbursement.
Impact: Proper sequencing preserves 100% payment on highest-value code versus 50% reduction if sequenced incorrectly
Document pathology confirmation of malignancy in medical record; some payers require pre-operative biopsy confirmation before authorizing excision codes.
Impact: Prevents downcoding to benign lesion codes (11423) which pay approximately $100-120 less
Code intermediate or complex closures separately (12031-13133) if performed; these are not bundled with excision codes and represent additional revenue.
Impact: Additional $150-400 revenue per procedure depending on repair complexity and location
For lesions at anatomic boundaries (e.g., exactly 2.0 cm vs 2.1 cm), document excised diameter measurements in two dimensions to support code selection during audits.
Impact: Prevents downcoding during audits and protects the $60-80 differential between code tiers

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11623 in 2025?

Medicare pays $287.56 for CPT 11623 in non-facility settings and $203.78 in facility settings based on the 2025 national average rates. Actual payment may vary by geographic locality based on GPCI adjustments.

How do I measure the lesion size for CPT 11623 coding?

Measure the excised diameter, which includes both the visible lesion and the margins of normal tissue removed around it. The total excised specimen must measure between 2.1 and 3.0 cm. Document measurements in the operative note and verify against pathology specimen size.

Can I bill CPT 11623 for benign lesions?

No. CPT 11623 is exclusively for malignant lesions. Benign lesion excisions of the same size and location are coded with CPT 11423. Pathology confirmation of malignancy is required for proper use of 11623.

What body areas are included in CPT 11623?

CPT 11623 applies to excisions on the scalp, neck, hands, feet, and genitalia only. Excisions of the same size malignant lesions on the trunk, arms, legs, or face use different codes (11603 for trunk/arms/legs, 11643 for face/ears/eyelids/nose/lips/mucous membranes).

Can I bill a closure code separately with CPT 11623?

Simple closure is included in CPT 11623 and cannot be billed separately. However, intermediate closures (12031-12057) and complex closures (13100-13133) may be reported separately when documentation supports the additional complexity of layered closure or extensive undermining.

What is the global period for CPT 11623?

CPT 11623 has a 10-day global period. All routine postoperative care for 10 days following the procedure is included in the reimbursement. Complications or unrelated services during this period may be billed separately with appropriate modifiers.

How many RVUs does CPT 11623 have?

CPT 11623 has 8.89 total RVUs: 3.11 work RVUs, 5.38 non-facility practice expense RVUs (2.79 facility PE RVUs), and 0.40 malpractice RVUs. These values are from the 2025 Medicare Physician Fee Schedule.