CPT 11643Surgery

Exc f/e/e/n/l mal+mrg 2.1-3

CPT 11643 covers surgical removal of a malignant (cancerous) skin lesion on the face, ears, eyelids, nose, or lips when the lesion measures 2.1 to 3.0 centimeters in diameter, including the margin removed around it.

Showing rates for

National Average

Base Medicare rate

$306.97

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

3.42

PE RVU (NF)

5.59

MP RVU

0.48

Total RVU

9.49

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 the original lesion size, as this determines code selection within the 11640-11646 family
Impact: Incorrect measurement can result in downcoding from 11643 to 11642 ($252.48 non-facility) or upcoding scrutiny if using 11644 ($412.28), representing $54.49-$105.31 per claim
Bill in the non-facility setting when performed in office to capture the full $306.97 rate versus $221.90 facility rate
Impact: Setting selection yields $85.07 (27.7%) higher reimbursement per procedure when performed in physician office
When performing multiple excisions, list the most complex or highest RVU procedure first without modifier 51, then append 51 or 59 to subsequent procedures to minimize payment reduction
Impact: Strategic sequencing prevents 50% reduction on higher-value codes; can preserve $100+ per claim when billing multiple lesions
Document pathology confirmation of malignancy and ensure diagnosis codes specify malignant neoplasm of specific facial site (C44.x codes) to support medical necessity
Impact: Prevents denials for lack of medical necessity; benign lesion codes will trigger automatic denials requiring refund or appeal
Do not separately bill for simple closure as it is included in the excision code; only bill complex repair (13100-13153) if performed and documented
Impact: Prevents unbundling denials while ensuring capture of additional $200-500 when intermediate or complex closure is legitimately performed
For planned staged re-excision after pathology shows positive margins, use modifier 58 and link to original pathology report to demonstrate medical necessity

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Frequently asked questions

What is the Medicare reimbursement for CPT 11643 in 2025?

Medicare pays $306.97 for CPT 11643 in non-facility settings and $221.90 in facility settings under the 2025 Physician Fee Schedule. The non-facility rate applies when performed in a physician office, while the facility rate applies in hospital outpatient departments or ambulatory surgery centers.

What size lesion excision does CPT 11643 cover?

CPT 11643 is used when the excised diameter (lesion plus margins) measures 2.1 to 3.0 centimeters. This is measured after excision, not the pre-operative clinical lesion size. If margins add to the clinical lesion size to create an excised diameter of 2.1-3.0 cm, code 11643 is appropriate.

Can I bill CPT 11643 with an E/M code on the same date?

Yes, but only with modifier 25 appended to the E/M code if a separately identifiable evaluation and management service was performed beyond the decision for surgery. The E/M must be documented as distinct from the surgical pre-operative assessment. Many payers scrutinize same-day E/M billing with procedures.

What diagnosis codes support medical necessity for CPT 11643?

CPT 11643 requires malignant neoplasm diagnosis codes, primarily C44.x series for malignant neoplasm of skin of specific facial sites (C44.0-C44.9). Common examples include C44.319 (basal cell carcinoma of nose), C44.319 (squamous cell carcinoma of nose), C44.399 (melanoma of nose). Benign lesion codes will result in denial.

How do I bill multiple malignant lesion excisions on the face?

List the highest-value or most complex excision first without modifier 51, then append modifier 59 or 51 to additional excisions. Each excision is coded separately based on its own excised diameter. Medicare applies a 50% reduction to the second procedure and subsequent procedures may be reduced further under multiple procedure payment reduction rules.

Is closure included in CPT 11643 or billed separately?

Simple closure is included in CPT 11643 and cannot be billed separately. Only intermediate (12051-12057) or complex repair (13100-13153) may be billed additionally if performed and documented. The repair code must match the anatomic site and size of the closure, and documentation must support the complexity level claimed.

What are the work RVUs for CPT 11643 in 2025?

CPT 11643 has 3.42 work RVUs, 5.59 practice expense RVUs (non-facility), 2.96 practice expense RVUs (facility), and 0.48 malpractice RVUs, for a total of 9.49 RVUs in non-facility settings. These RVUs are multiplied by the 2025 conversion factor of 32.3465 to calculate Medicare payment.