CPT 11642Surgery

Exc f/e/e/n/l mal+mrg 1.1-2

CPT 11642 is used when a physician surgically removes a cancerous or potentially cancerous skin lesion (including melanoma) from the face, ears, eyelids, nose, or lips that measures between 1.1 and 2.0 centimeters, plus a margin of healthy tissue around it.

Showing rates for

National Average

Base Medicare rate

$260.39

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

2.62

PE RVU (NF)

5.1

MP RVU

0.33

Total RVU

8.05

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

NCCI bundling edits

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Billing tips

Accurately measure and document the excised diameter (lesion plus margins) not just the clinical lesion size; the excised diameter determines code selection and 11642 requires 1.1-2.0 cm total
Impact: Incorrect measurement documentation causes up to 40% of denials; upcoding from 11641 (≤1.0 cm, $192.58) to 11642 ($260.39) requires clear documentation of excised diameter, representing $67.81 difference
Bill in non-facility settings when possible to capture the $83.13 differential between non-facility ($260.39) and facility ($177.26) rates
Impact: Office-based procedures yield 47% higher reimbursement than hospital outpatient settings; annual volume of 100 cases represents $8,313 additional revenue
Obtain and reference pathology confirmation of malignancy with specific ICD-10 diagnosis codes; never bill excision of malignant lesion codes without pathologic diagnosis or strong clinical suspicion documented
Impact: Billing 11642 without confirmed or suspected malignancy results in 90%+ denial rate; use 11442 (excision benign lesion) if no malignancy suspected, which reimburses at $225.87, avoiding potential fraud allegations
Document anatomical location with specificity (which facial subunit, which part of ear, upper vs lower eyelid) as excisions from face/ears/eyelids/nose/lips reimburse higher than trunk/extremities
Impact: 11642 (face/ears/eyelids/nose/lips) pays $260.39 vs 11602 (trunk/arms/legs 1.1-2.0 cm) at $189.26, a $71.13 difference per procedure; vague location documentation risks downcoding
For multiple excisions, list procedures in descending RVU order with highest-value procedure first (no modifier) and apply modifier 51 to subsequent procedures
Impact: Proper sequencing maximizes reimbursement under multiple procedure payment reduction rules; incorrect ordering can result in 5-10% lost revenue across all procedures

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Frequently asked questions

What is the Medicare reimbursement for CPT code 11642 in 2025?

Medicare pays $260.39 for CPT 11642 in non-facility settings (office) and $177.26 in facility settings (hospital outpatient) based on the 2025 national average rate. The non-facility rate is 47% higher because it includes practice expense for equipment, supplies, and space, while facility rates assume the hospital provides these resources.

What size lesion qualifies for CPT code 11642?

CPT 11642 requires an excised diameter (lesion plus margins) of 1.1 to 2.0 centimeters. This is not the clinical lesion size but the total diameter of tissue removed including surrounding margins. For example, a 0.7 cm lesion excised with 0.3 cm margins would have an excised diameter of 1.3 cm, qualifying for 11642.

What is the difference between CPT 11642 and 11602?

Both codes describe excision of malignant lesions sized 1.1-2.0 cm excised diameter, but 11642 is for high-risk anatomical locations (face, ears, eyelids, nose, lips) paying $260.39, while 11602 is for trunk, arms, and legs paying $189.26. The $71.13 difference reflects the increased complexity and cosmetic sensitivity of facial excisions.

Can I bill an E/M visit with CPT 11642 on the same day?

Yes, you can bill an E/M service with 11642 on the same day using modifier 25 on the E/M code, but only if the E/M represents a significant, separately identifiable service beyond the decision for surgery. Documentation must clearly show evaluation of other conditions or substantial assessment beyond the routine pre-operative evaluation for the excision.

How many RVUs is CPT code 11642 worth?

CPT 11642 has a total of 8.05 RVUs consisting of 2.62 work RVUs, 5.1 non-facility practice expense RVUs (2.53 facility PE RVUs), and 0.33 malpractice RVUs. When multiplied by the 2025 conversion factor of 32.3465, this yields the $260.39 non-facility payment rate.

Is closure included in CPT 11642 or billed separately?

Simple (one-layer) closure is included in CPT 11642 and cannot be billed separately. However, if intermediate closure (layered closure of one or more deeper layers, 12051-12057) or complex closure (requiring extensive undermining, stents, or retention sutures, 13151-13153) is performed, these may be billed separately with appropriate documentation of the increased closure complexity.

What diagnosis codes are appropriate for billing CPT 11642?

Appropriate ICD-10 codes include C44.xx (malignant neoplasm of skin) with specific fifth and sixth characters for facial location (C44.01-C44.09 for lip, C44.11-C44.19 for eyelid, C44.21-C44.29 for ear, C44.31-C44.39 for nose, C44.31-C44.399 for other face), D03.xx (melanoma in situ of specified sites), or D04.xx (carcinoma in situ of skin). The diagnosis must support medical necessity for excision of a malignant lesion.