CPT 11644Surgery

Exc f/e/e/n/l mal+mrg 3.1-4

CPT 11644 covers the surgical removal of a malignant (cancerous) skin lesion from the face, ears, eyelids, nose, or lips when the lesion measures between 3.1 and 4.0 centimeters, including the margin of normal tissue removed around it.

Showing rates for

National Average

Base Medicare rate

$378.13

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

4.34

PE RVU (NF)

6.72

MP RVU

0.63

Total RVU

11.69

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

NCCI bundling edits

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Billing tips

Measure the excised diameter (lesion plus margins) not the clinical lesion size alone. The difference between 3.0 cm (code 11643, $301.16) and 3.1 cm (code 11644, $378.13) is $76.97.
Impact: $76.97 difference in reimbursement between adjacent size codes; proper measurement documentation prevents $76.97 downcoding
Document anatomic location precisely using terms 'face,' 'ear,' 'eyelid,' 'nose,' or 'lip' in operative note. Vague terms like 'head' or 'periorbital' may trigger downcoding to lower-paying trunk/extremity codes (11606, $232.28).
Impact: Prevents $145.85 loss from downcoding to non-facial location codes
Bill separately for complex layered closure using 13151-13153 series if closure requires layered closure of one or more deeper layers. Simple/intermediate closures are included in the excision.
Impact: Additional $200-500 in reimbursement when complex repair is appropriately documented and billed
When pathology confirms malignancy, ensure diagnosis code reflects confirmed malignancy (C44.x series), not 'history of' or 'suspected.' Benign pathology results require refund or corrected claim to benign excision codes (11441-11446).
Impact: Prevents post-payment audits and recoupment; malignant vs benign coding affects medical necessity
For Medicare, verify patient has had qualifying biopsy or clinical diagnosis documented before excision. Medicare LCDs require diagnostic confirmation in many jurisdictions.
Impact: Prevents medical necessity denials; ensures compliance with local coverage determinations
Bill facility vs non-facility correctly. Office excisions receive $378.13 (non-facility), ASC/hospital outpatient receive $273.97 (facility), a difference of $104.16 that affects practice overhead calculations.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11644 in 2025?

Medicare pays $378.13 for CPT 11644 in non-facility settings (office) and $273.97 in facility settings (ASC/hospital outpatient) based on the 2025 national average. Actual payments vary by geographic locality using GPCI adjustments.

How do you measure lesion size for CPT 11644 billing?

Measure the excised diameter, which includes both the clinical lesion size plus the margins removed around it. For 11644, the total excised diameter must be 3.1 to 4.0 cm. For example, a 2.5 cm lesion with 0.5 cm margins equals 3.5 cm excised diameter, qualifying for 11644.

Can CPT 11644 be billed with an E/M code on the same day?

Yes, but only if a separately identifiable evaluation and management service is performed and documented beyond the typical pre-operative assessment. Append modifier 25 to the E/M code and ensure documentation clearly shows the distinct nature of the E/M service, such as evaluation of unrelated conditions or significant separate history and examination.

What anatomic locations qualify for CPT 11644?

CPT 11644 is specific to face, ears, eyelids, nose, and lips (f/e/e/n/l in the code descriptor). Excisions on the neck, scalp, trunk, or extremities use different code series (11600-11606 for trunk/extremities, 11620-11626 for scalp/neck/hands/feet) even if the same size.

What diagnosis codes are appropriate for billing CPT 11644?

Use confirmed malignant neoplasm codes from the C44.x series (malignant neoplasm of skin) with the appropriate fourth, fifth, and sixth characters for specific facial location and histology. Common examples include C44.319 (basal cell carcinoma of nose), C44.311 (basal cell carcinoma of cheek), and C44.319 (squamous cell carcinoma of face).

How many RVUs is CPT code 11644 worth in 2025?

CPT 11644 has 11.69 total RVUs in 2025, consisting of 4.34 work RVUs, 6.72 practice expense RVUs (non-facility), 3.5 practice expense RVUs (facility), and 0.63 malpractice RVUs. These are multiplied by the conversion factor of 32.3465 to determine payment.

What is the difference between CPT 11644 and 11643?

The only difference is excised diameter size: 11643 covers 2.1-3.0 cm ($301.16 Medicare payment) while 11644 covers 3.1-4.0 cm ($378.13 Medicare payment). Both are for malignant lesions on face/ears/eyelids/nose/lips. Accurate measurement documentation is critical, as the $76.97 difference makes this a common audit target.