CPT code 11426: Benign lesion excision, scalp, neck, hands, feet, genitalia2026 Medicare rate & RVUs

Medicare pays $340.02 for 11426 nationally in the office and $244.83 in a hospital or facility. Local office rates run $303.52–$426.70.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 11426 covers

This code is for surgical removal of a benign skin lesion with a total excised diameter greater than 4 cm, including the lesion and its margins. Typical cases include a large benign nevus or cyst on the scalp, hand, or foot. A physician or other qualified practitioner performs the excision in an office, clinic, or surgical setting; the specimen may be sent for pathology.

Choose the code by the anatomic group and the excised diameter, which includes the lesion plus the narrowest margins—not by lesion size alone. Document the site, lesion dimensions, margins, total excised diameter, and diagnosis; record the closure type and length if a separately reportable repair is performed. Simple closure is included, while intermediate or complex repair may be reported separately when supported. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this descriptor. Assistant-at-surgery payment is barred, and co-surgeon and team-surgery reporting are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 11426 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

11426 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 11426 rate is calculated

Each of 11426’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 11426

11426 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

11426 compared with similar codes

How to choose

11424Lesion excisionScalp, neck, hands, feet, genitalia

Both codes cover benign lesion excision in the same anatomic group. Choose 11424 when the total excised diameter is 3.1 to 4 cm; choose 11426 when it exceeds 4 cm.

11406Skin lesion excisionTrunk or extremity, over 4 cm

This code is for the scalp, neck, hands, feet, or genitalia. Code 11406 covers the trunk, arms, or legs for a benign lesion larger than 4 cm.

11446Skin lesion excisionFace, over 4 cm

Use 11446 for a benign lesion larger than 4 cm on the face, ears, eyelids, nose, lips, or mucous membrane; 11426 covers a different anatomic group.

11626Skin excisionScalp, neck, hands, feet, genitalia; over 4 cm

The anatomic group and size threshold are similar, but 11626 is for malignant lesions. This code is for benign lesions.

Codes related to 11426

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates