CPT 11646Surgery

Exc f/e/e/n/l mal+mrg >4 cm

CPT code 11646 covers the surgical removal of a malignant (cancerous) skin lesion larger than 4 centimeters from the face, ears, eyelids, nose, or lips, including margins to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$491.02

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

6.26

PE RVU (NF)

7.93

MP RVU

0.99

Total RVU

15.18

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 just the lesion size. The excised diameter determines code selection and must exceed 4.0 cm for 11646.
Impact: Incorrect measurement documentation can result in downcoding to 11644 (3.1-4.0 cm at $381.24), creating a $109.78 loss per claim
Submit pathology report with claim showing malignancy confirmation. Pre-operative biopsy or post-operative histopathology must confirm malignant diagnosis.
Impact: Without pathology proof of malignancy, payers will deny or downcode to benign lesion codes (11446 series), reducing payment by approximately 30-40%
Bill in non-facility setting when performed in office with appropriate equipment. The non-facility rate is $113.54 higher than facility rate.
Impact: Performing in-office versus hospital outpatient increases practice revenue by $113.54 per procedure (23% increase from $377.48 to $491.02)
Document exact anatomical location within face/ears/eyelids/nose/lips region. Lesions on scalp, neck, or trunk use different code families.
Impact: Incorrect anatomical coding can trigger denial or audit; face/ears/eyelids/nose/lips codes reimburse higher than trunk codes due to complexity
For complex closures requiring extensive undermining, layered closure, or significant tissue rearrangement, consider adding appropriate closure codes (12051-12057 for face)
Impact: Intermediate closures >2.5 cm can add $200-500 in additional reimbursement when complexity is documented beyond simple repair included in excision
When multiple lesions are excised, list largest/most complex first without modifier 51, then append modifier 51 to subsequent codes to maximize reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 11646 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 11646 is $491.02 in non-facility settings and $377.48 in facility settings. Actual rates may vary by geographic locality based on the GPCI (Geographic Practice Cost Index) adjustment.

How do you measure lesion size for CPT code 11646?

For CPT 11646, measure the excised diameter, which includes both the lesion and the margins removed around it. The total excised diameter must exceed 4.0 cm. Measure the greatest clinical diameter of the entire excised tissue, not just the visible lesion. Document this measurement in the operative report.

What is the difference between CPT 11646 and 11644?

CPT 11646 is for excision of malignant lesions greater than 4.0 cm in excised diameter, while CPT 11644 covers lesions 3.1 to 4.0 cm. Both apply to face, ears, eyelids, nose, and lips. The reimbursement difference is significant: 11646 pays $491.02 versus 11644 at $381.24 (non-facility), making accurate measurement documentation critical.

Can CPT 11646 be billed with a closure code?

Simple closure is included in CPT 11646 and cannot be billed separately. However, intermediate (12051-12057) or complex closures (13151-13153) may be separately billable when the complexity of repair exceeds simple closure and involves layered closure, significant undermining, or extensive tissue rearrangement. Documentation must clearly support the additional complexity.

What diagnosis codes are appropriate for CPT 11646?

CPT 11646 requires ICD-10 codes for malignant neoplasms of the specified anatomical sites: C44.01-C44.09 (malignant neoplasm of skin of lip), C44.301-C44.309 (skin of other and unspecified parts of face), C44.2x (skin of ear), C44.1x (eyelid), C44.301-C44.309 (nose). The pathology must confirm malignancy.

Does CPT 11646 have a global period?

Yes, CPT 11646 has a 90-day global surgical period. This means all routine post-operative care for 90 days following the procedure is included in the reimbursement. Complications, unrelated procedures, or return to OR for related issues during this period require appropriate modifiers (24, 78, 79) for separate payment.

What are the work RVUs for CPT code 11646?

CPT 11646 has 6.26 work RVUs, 7.93 practice expense RVUs (non-facility), 4.42 practice expense RVUs (facility), and 0.99 malpractice RVUs, for a total of 15.18 non-facility RVUs. These values reflect the significant physician work and practice resources required for excising large malignant lesions in cosmetically sensitive facial areas.