CPT 11640Surgery

Exc f/e/e/n/l mal+mrg 0.5cm<

CPT code 11640 covers surgical removal of a small malignant (cancerous) skin lesion on the face, ears, eyelids, nose, or lips, including a margin of healthy tissue, when the lesion is 0.5 centimeters or smaller.

Showing rates for

National Average

Base Medicare rate

$196.99

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

1.67

PE RVU (NF)

4.21

MP RVU

0.21

Total RVU

6.09

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

NCCI bundling edits

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Billing tips

Measure and document the lesion size (greatest clinical diameter) PLUS the narrowest margin in the operative note to justify code selection. For 11640, the total excised diameter must be clearly stated.
Impact: Inadequate size documentation is the #1 cause of downcoding from 11640 to evaluation/biopsy codes, resulting in $150-180 loss per claim
Verify pathology confirms malignancy before billing 11640. If pathology returns benign, code must be changed to 11440 (benign lesion excision) which pays $158.69 non-facility vs $196.99 for malignant.
Impact: Billing malignant code without pathology confirmation constitutes incorrect coding and creates $38.30 overpayment subject to recoupment and potential fraud investigation
Bill in non-facility setting when performed in office to capture the higher rate of $196.99 vs facility rate of $123.89. Ensure your place of service code is 11 (office).
Impact: Incorrect place of service coding costs $73.10 per procedure (37% reduction in reimbursement)
For multiple lesions excised in same session, bill each separately with modifier 51 on secondary procedures, ranking by RVU value (highest first). Do not use modifier 51 on the primary/highest valued procedure.
Impact: Proper modifier 51 sequencing maximizes reimbursement; incorrect sequencing can reduce total payment by 10-25% on multi-lesion cases
When performing excision same day as biopsy that confirmed malignancy, bill only the excision (11640). If biopsy was performed on a different date or different lesion, bill separately with appropriate documentation.
Impact: Attempting to bill both biopsy and excision of same lesion on same date results in biopsy denial due to NCCI edits, but properly documented separate lesion biopsies can add $150+ per additional lesion

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11640 in 2025?

The 2025 Medicare national average reimbursement for CPT 11640 is $196.99 when performed in a non-facility setting (office) and $123.89 when performed in a facility setting (hospital outpatient or ASC). Actual rates may vary by geographic locality based on the GPCI adjustment factors.

What size lesion qualifies for CPT code 11640?

CPT 11640 is used when the excised diameter (lesion plus margins) is 0.5 cm or less. This typically represents a very small lesion (3-4mm) with narrow margins. Measure the greatest clinical diameter of the lesion plus the narrowest margin to determine total excised diameter. If the total excised diameter exceeds 0.5 cm, use codes 11641-11646 based on size.

Can I bill CPT 11640 and an E/M visit on the same day?

Yes, you can bill an E/M service on the same day as CPT 11640 if the E/M represents a separately identifiable service beyond the usual pre-operative assessment. Append modifier 25 to the E/M code and ensure documentation clearly shows the E/M addressed separate concerns (evaluation of other lesions, management of other conditions, etc.). The E/M note should be distinct from the procedure note.

What is the difference between CPT 11640 and 11440?

CPT 11640 is for excision of malignant lesions on the face/ears/eyelids/nose/lips, while 11440 is for benign lesions in the same locations with the same size range (≤0.5 cm). The key difference is pathology: malignancy must be confirmed by pathology report to use 11640. The malignant code (11640) reimburses at $196.99 vs $158.69 for the benign code (11440) in non-facility settings.

How many RVUs is CPT code 11640 worth?

CPT 11640 has a total of 6.09 RVUs for 2025, consisting of 1.67 work RVUs, 4.21 practice expense RVUs (non-facility), and 0.21 malpractice RVUs. In the facility setting, practice expense RVUs are reduced to 1.95, resulting in a lower total payment.

Does CPT 11640 include closure of the wound?

Yes, CPT 11640 includes simple (single layer) closure. You cannot separately bill for simple closure (12011-12018) when performed as part of the excision. However, if intermediate (layered) closure or complex (scar revision, extensive undermining) closure is required, you may bill separately using codes 12051-12057 for intermediate or 13100-13133 for complex closure, though this may require additional documentation to overcome NCCI edits.

What documentation is needed to bill CPT 11640?

Required documentation includes: (1) pathology report confirming malignancy, (2) exact anatomic location on face/ears/eyelids/nose/lips, (3) lesion size measurement (greatest clinical diameter), (4) margin width taken, (5) total excised diameter to justify code selection, (6) description of excision depth and technique, (7) closure method, and (8) specimen sent to pathology. Missing measurements are the most common reason for denials and downcoding.