CPT 11624Surgery

Exc s/n/h/f/g mal+mrg 3.1-4

CPT 11624 covers surgical removal of a malignant (cancerous) skin lesion including margins when the lesion measures between 3.1 and 4.0 centimeters on the scalp, neck, hands, feet, or genitals. This includes cutting out the cancerous tissue plus a rim of healthy tissue around it to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$327.35

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

3.62

PE RVU (NF)

5.99

MP RVU

0.51

Total RVU

10.12

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

NCCI bundling edits

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Billing tips

Measure and document the excised diameter (lesion plus margins), not just the visible lesion size; the excised diameter determines the correct CPT code
Impact: Correct measurement documentation prevents downcoding from 11624 ($327.35) to 11623 (typically $275), a difference of approximately $52 per case
Verify anatomic site matches the s/n/h/f/g designation (scalp/neck/hands/feet/genitalia) before billing 11624; trunk or extremity lesions use different code series (11603-11606)
Impact: Wrong code family results in automatic denial or recoupment; non-facility rate difference between 11624 and comparable trunk code 11604 is approximately $80
Bill separately for complex closure (13100-13153) or intermediate closure (12031-12057) only if documented complexity exceeds simple closure; 11624 includes simple closure
Impact: Appropriate complex closure billing can add $200-600 to reimbursement, but unbundling simple closure results in denial and potential audit exposure
When performing multiple excisions, list procedures in descending RVU order with modifier 51 on second and subsequent procedures to maximize reimbursement
Impact: Proper sequencing ensures highest-paying procedure receives 100% payment; incorrect ordering can reduce total payment by $50-150
For facility billing, recognize the $96.07 rate differential between non-facility ($327.35) and facility ($231.28) settings; verify place of service code accuracy
Impact: Incorrect POS code 11 vs 22 results in $96.07 underpayment per claim and potential recoupment during audits
Obtain and document pathology report confirming malignancy; append diagnosis code for specific malignancy type (C43.x, C44.x) rather than unspecified neoplasm

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11624 in 2025?

Medicare pays $327.35 for CPT 11624 in non-facility settings and $231.28 in facility settings based on the 2025 national average. Actual payment varies by geographic locality based on GPCI adjustments. The code has 10.12 total RVUs (3.62 work RVU, 5.99 non-facility PE RVU, 3.02 facility PE RVU, and 0.51 malpractice RVU).

How do you measure the lesion size for billing CPT 11624?

Measure the excised diameter, which includes the visible lesion plus the margins removed around it. For 11624, the total excised diameter must measure between 3.1 and 4.0 centimeters. The measurement should be taken of the actual specimen removed, not just the pre-excision lesion size, and must be documented in the operative note.

Can you bill CPT 11624 with a closure code?

Simple closure is included in 11624 and cannot be billed separately. You may bill intermediate closure (12031-12057) or complex closure (13100-13153) separately only when the closure complexity exceeds simple closure and is clearly documented. Complex repairs involving layered closure of one or more deeper layers may qualify for separate payment.

What anatomic sites are appropriate for CPT 11624?

CPT 11624 is designated for scalp, neck, hands, feet, and genitalia only (abbreviated as s/n/h/f/g in the code descriptor). Malignant lesion excisions from the trunk, arms, legs, face, ears, eyelids, nose, lips, or mucous membranes require different CPT codes from other code families.

What diagnosis codes support medical necessity for CPT 11624?

Use specific malignant neoplasm ICD-10 codes such as C43.x (malignant melanoma), C44.x (other malignant neoplasms of skin), or D04.x (carcinoma in situ) with the appropriate fourth, fifth, and sixth characters indicating the specific anatomic site. Pathology confirmation of malignancy is required; unspecified neoplasm codes (D49.2) often trigger denials.

How many times can you bill CPT 11624 on the same day?

You can bill 11624 multiple times on the same day if multiple separate lesions meeting the size and site criteria are excised. Use modifier 59 or XS to indicate distinct procedural services at different anatomic sites. Apply modifier 51 to the second and subsequent procedures, which will reimburse at 50% of the allowed amount.

What is the global period for CPT 11624?

CPT 11624 has a 90-day global period, meaning routine postoperative care for 90 days after the procedure is included in the base payment. Any related procedures during this period require modifier 78 (return to OR) or 79 (unrelated procedure), and separately identifiable E/M services require modifier 25 or are included in the global package.