CPT 11641Surgery

Exc f/e/e/n/l mal+mrg 0.6-1

CPT 11641 covers the surgical removal of a malignant (cancerous) skin lesion measuring 0.6 to 1.0 centimeters on the face, ears, eyelids, nose, or lips, including a margin of healthy tissue around it.

Showing rates for

National Average

Base Medicare rate

$229.98

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

2.17

PE RVU (NF)

4.66

MP RVU

0.28

Total RVU

7.11

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

NCCI bundling edits

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Billing tips

Measure the lesion diameter PLUS margins in the pathology report, not just clinical pre-excision size, to determine correct code selection
Impact: Upcoding from 11640 (≤0.5cm, $181.76) to 11641 ($229.98) represents $48.22 (26.5%) increase; documentation must support excised diameter
Document anatomic location precisely using facial subsite terminology (nasal ala, upper cutaneous lip, helix of ear) rather than generic 'face' to withstand audits
Impact: Prevents downcoding to non-facial excision codes (11600-11606 series) which pay approximately 30-40% less due to lower complexity
Bill intermediate (12051-12057) or complex closure (13151-13153) separately when layered repair or undermining is performed; simple closure is bundled
Impact: Additional $150-400+ depending on closure complexity and size; requires documentation of technique (layered, undermining, extensive debridement)
For multiple lesions excised same session, bill largest lesion at full code (11641) and additional lesions with modifier 59 using size-appropriate codes
Impact: Second lesion typically paid at 50% ($114.99 for facility, $76.02 for non-facility); proper sequencing maximizes reimbursement
Choose place of service carefully: office (11) vs. ASC (24) vs. hospital outpatient (22) affects facility vs. non-facility rate difference of $77.95 per excision
Impact: Non-facility rate $229.98 vs. facility rate $152.03; performing in office when safe increases physician payment by 51.3%
Submit pathology report with claim for malignant diagnosis (C44.x codes) to prevent denials; payers often request to verify medical necessity

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Frequently asked questions

What is the Medicare reimbursement for CPT 11641 in 2025?

The 2025 Medicare national average reimbursement for CPT 11641 is $229.98 for non-facility settings and $152.03 for facility settings. Actual payment varies by geographic location based on MAC locality adjustments to the base conversion factor of 32.3465.

What size lesion qualifies for CPT code 11641?

CPT 11641 is used for excised diameters from 0.6 cm up to and including 1.0 cm. This measurement includes the lesion plus margins as documented in the final pathology report, not just the pre-excision clinical measurement. If the excised diameter is 0.5 cm or less, use 11640; if greater than 1.0 cm, use 11642 or higher.

Can I bill CPT 11641 with an E/M code on the same day?

Yes, but you must append modifier 25 to the E/M code and document a separately identifiable evaluation beyond the standard pre-procedure assessment. The E/M must address a distinct problem or involve significant separate decision-making. Simply deciding to perform the excision does not qualify for separate E/M payment.

What anatomic locations are covered by CPT 11641?

CPT 11641 applies exclusively to malignant lesion excisions on the face, ears, eyelids, nose, lips (including vermilion border and mucous membrane). For lesions on the neck, trunk, arms, legs, hands, or feet, use the 11600-11606 code series instead, which reimburses at lower rates.

How do I bill for closure with CPT 11641?

Simple closure is included in CPT 11641 and cannot be billed separately. However, intermediate closures (12051-12057) requiring layered closure or extensive undermining, or complex closures (13151-13153) requiring more than layered closure, can be billed separately with appropriate documentation of the technique used.

What is the RVU value for CPT code 11641?

CPT 11641 has a total RVU of 7.11 for 2025, consisting of 2.17 work RVUs, 4.66 practice expense RVUs (non-facility), 2.25 practice expense RVUs (facility), and 0.28 malpractice RVUs. These values are multiplied by the conversion factor 32.3465 to determine Medicare payment.

How many times can I bill CPT 11641 on the same day?

You can bill CPT 11641 multiple times on the same day for separate, distinct lesions by using modifier 59 on subsequent excisions. List the largest excision first without modifier, then add modifier 59 to additional lesions. Most payers reimburse the second and subsequent excisions at 50% of the allowed amount, and documentation must clearly show separate lesions in different anatomic sites.