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

Reports excision of a benign skin lesion larger than 4 cm, including margins, from the scalp, neck, hands, feet, or genitalia.

CMS RVU26DEffective Oct 1, 2026One payment locality3.7K Medicare services in 2024

In Puerto Rico, Medicare pays $341.74 for 11426 in the office and $245.50 when it’s performed in a hospital or facility.

$341.74Office (non-facility)
$245.50Hospital or facility
+0.5%vs the national office rate ($340.02)

Check a contract rate as a % of Medicare · 11426 nationwide

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

We’ll open 11426 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 11426 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for 11426

Across 109 of 109 payment localities, the office rate for 11426 runs from $303.52 in Arkansas to $426.70 in San Benito County, CA. Puerto Rico pays $341.74. The RVUs are the same everywhere; the geographic indexes change the dollars.

11426 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$341.74
  2. Los Angeles, CA · California$372.23+$30.49
  3. Washington, DC area · District of Columbia$382.63+$40.89
  4. Miami, FL · Florida$380.31+$38.57
  5. Chicago, IL · Illinois$369.56+$27.82
  6. Manhattan, NY · New York$391.11+$49.37
  7. Alaska · Alaska$409.11+$67.37

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

11426 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$307.57$224.28
ArkansasArkansas$303.52$221.75
ArizonaArizona$331.20$238.95
Bakersfield, CACalifornia$351.99$247.66
Chico, CACalifornia$350.16$245.83
El Centro, CACalifornia$350.27$245.94
Fresno, CACalifornia$350.16$245.83
Hanford, CACalifornia$350.16$245.83

11426 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$303.52

$409.11

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
11426 office rate range by state
State / territoryOffice rate rangeLocalities
AK$409.111
AL$307.571
AR$303.521
AZ$331.201
CA$350.16–$426.7029
CO$348.801
CT$361.451
DC$382.631
DE$336.301
FL$342.62–$380.313
GA$324.10–$347.682
GU$356.421
HI$356.421
IA$311.371
ID$313.931
IL$335.93–$369.564
IN$315.501
KS$311.621
KY$317.631
LA$317.81–$331.992
MA$347.64–$379.102
MD$341.83–$382.633
ME$317.11–$330.462
MI$326.65–$348.202
MN$330.351
MO$313.88–$331.173
MS$308.671
MT$339.981
NC$319.881
ND$327.321
NE$312.451
NH$344.951
NJ$364.48–$379.532
NM$328.931
NV$336.641
NY$324.40–$401.915
OH$324.061
OK$315.421
OR$332.93–$357.262
PA$323.64–$354.152
PR$341.741
RI$346.361
SC$322.731
SD$325.831
TN$313.251
TX$321.82–$348.608
UT$326.721
VA$330.59–$382.632
VI$341.741
VT$327.611
WA$346.47–$384.852
WI$317.441
WV$324.951
WY$334.461

See 11426 in every payment locality

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.

How the rate is built · 11426

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.99

3.99 RVUs× 1.000 GPCI

Practice expense5.55

5.55 RVUs× 1.000 GPCI

Malpractice0.64

0.64 RVUs× 1.000 GPCI

Adjusted RVUs

10.1800

Conversion factor

$33.4009

Medicare rate

$340.02

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,320

Code
11426
Physician work
3.99
Practice expense
5.55
Malpractice
0.64

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 11426 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.99× 1.0003.9900
Practice expense5.55× 1.0115.6110
Malpractice0.64× 0.9850.6304
Total RVUs10.2315
Conversion factor× 33.4009

Office rate, Puerto Rico$341.74

Office: (3.99 × 1 + 5.55 × 1.011 + 0.64 × 0.985) × $33.4009 = $341.74

Facility: (3.99 × 1 + 2.7 × 1.011 + 0.64 × 0.985) × $33.4009 = $245.50

Open 11426 in the RVU calculator

Payment rules and modifiers for 11426

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

CMS payment indicators · 11426

Benign lesion excision, scalp, neck, hands, feet, genitalia

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 11426

Benign lesion excision, scalp, neck, hands, feet, genitalia

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

11426 without 51 · national office

$340.02

Benign lesion excision, scalp, neck, hands, feet, genitalia

11426-51 · Second procedure: 50%

$170.01

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 11426

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

Codes related to 11426
CodeHow it relatesOffice range, Puerto Rico
Same family
11424Lesion excision, scalp, neck, hands, feet, genitaliaSame anatomic group; selected when the total excised diameter is 3.1 to 4 cm.$245.30
Used instead
11406Skin lesion excision, trunk or extremity, over 4 cmFor a benign lesion larger than 4 cm on the trunk, arms, or legs.$335.53
11446Skin lesion excision, face, over 4 cmFor a benign lesion larger than 4 cm on the face, ears, eyelids, nose, lips, or mucous membrane.$400.55
11626Skin excision, scalp, neck, hands, feet, genitalia; over 4 cmFor a malignant lesion larger than 4 cm in this anatomic group.$421.48
Often billed with
12042Intermediate wound repair, neck, hands, feet, or genitaliaMay report a separately documented intermediate repair of the relevant site and length.$307.04

How 11426 has changed in Puerto Rico

11426 · Office / nonfacility

$341.74

Effective 2026-10-01

The base rate is $19.08 higher than on 2025-10-01, moving from $322.66 to $341.74 (5.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $322.66changed to$341.74

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.09 changed to 3.99
    • Practice expense RVU 5.22 changed to 5.55
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $330.04changed to$322.66

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.17 changed to 5.22
    • Malpractice RVU 0.63 changed to 0.64

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $324.65changed to$330.04

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $336.53changed to$324.65

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.16 changed to 5.17
    • Malpractice RVU 0.65 changed to 0.63
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $335.48changed to$336.53

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $344.41changed to$335.48

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.18 changed to 5.16
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $347.96changed to$344.41

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.19 changed to 5.18
    • Malpractice RVU 0.66 changed to 0.65

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $348.65changed to$347.96

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.86 changed to 5.19
    • Malpractice RVU 0.68 changed to 0.66
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $346.55changed to$348.65

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.76 changed to 4.86
    • Malpractice RVU 0.74 changed to 0.68
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $345.08changed to$346.55

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.73 changed to 4.76

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $306.99changed to$345.08

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.66 changed to 4.73
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $271.18changed to$306.99

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.63 changed to 4.66
    • Malpractice RVU 0.75 changed to 0.74
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $271.80changed to$271.18

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.62 changed to 4.63
    • Malpractice RVU 0.74 changed to 0.75

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $270.45changed to$271.80

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $266.65changed to$270.45

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.58 changed to 4.62
    • Malpractice RVU 0.68 changed to 0.74
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $262.35changed to$266.65

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.08 changed to 4.58
    • Malpractice RVU 0.71 changed to 0.68
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $262.35

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$341.74$245.50RVU26D
2026-07-01$341.74$245.50RVU26C
2026-04-01$341.74$245.50RVU26B
2026-01-01$341.74$245.50RVU26A
2025-10-01$322.66$264.68RVU25D
2025-07-01$322.66$264.68RVU25C
2025-04-01$322.66$264.68RVU25B
2025-01-01$322.66$264.68RVU25A
2024-10-01$330.04$268.70RVU24D
2024-07-01$330.04$268.70RVU24C
2024-04-01$330.04$268.70RVU24B
2024-03-09$330.04$268.70RVU24AR
2024-01-01$324.65$264.31RVU24A
2023-10-01$336.53$273.00RVU23D
2023-07-01$335.48$272.45RVU23C
2023-04-01$335.48$272.45RVU23B
2023-01-01$335.48$272.45RVU23A
2022-10-01$344.41$277.44RVU22D
2022-07-01$344.41$277.44RVU22C
2022-04-01$344.41$277.44RVU22B
2022-01-01$344.41$277.44RVU22A
2021-10-01$347.96$279.73RVU21D
2021-07-01$347.96$279.73RVU21C
2021-04-01$347.96$279.73RVU21B
2021-01-01$347.96$279.73RVU21A
2020-10-01$348.65$285.35RVU20D
2020-07-01$348.65$285.35RVU20C
2020-04-01$348.65$285.35RVU20B
2020-01-01$348.65$285.35RVU20A
2019-10-01$346.55$286.31RVU19D
2019-07-01$346.55$286.31RVU19C
2019-04-01$346.55$286.31RVU19B
2019-01-01$346.55$286.31RVU19A
2018-10-01$345.08$285.99RVU18D
2018-07-01$345.08$285.99RVU18C
2018-04-01$345.08$285.99RVU18B
2018-01-01$345.08$285.99RVU18AR1
2017-10-01$306.99$258.15RVU17D
2017-07-01$306.99$258.15RVU17C
2017-04-01$306.99$258.15RVU17B
2017-01-01$306.99$258.15RVU17A
2016-10-01$271.18$231.30RVU16D
2016-07-01$271.18$231.30RVU16C
2016-04-01$271.18$231.30RVU16B
2016-01-01$271.18$231.30RVU16A
2015-10-01$271.80$232.03RVU15D
2015-07-01$271.80$232.03RVU15C
2015-04-01$270.45$230.87RVU15B
2015-01-01$270.45$230.87RVU15A
2014-10-01$266.65$227.73RVU14D
2014-07-01$266.65$227.73RVU14C
2014-04-01$266.65$227.73RVU14B
2014-01-01$266.65$227.73RVU14A
2013-10-01$262.35$221.75RVU13D
2013-07-01$262.35$221.75RVU13C
2013-04-01$262.35$221.75RVU13B
2013-01-01$262.35$221.75RVU13AR

Price 11426 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

11426 billing questions

How is the greater-than-4-cm threshold measured?

Use the total excised diameter: the lesion plus the narrowest margins. Document the lesion dimensions, margins, and resulting excised diameter.

When should 11424 be used instead?

Use 11424 for the same anatomic group when the total excised diameter is 3.1 to 4 cm. This code is for a diameter greater than 4 cm.

Is wound closure included?

Simple closure is included. An intermediate or complex repair may be separately reported when performed and documented; select the repair code by its site, type, and length.

Can modifier 50 be used for lesions on both sides?

No. Modifier 50 is inappropriate for this descriptor. Report each separately excised lesion according to its site and total excised diameter.

What postoperative care is included?

Related postoperative visits during the 10-day global period are included in the procedure.

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

Show the CMS file lines behind this rate
RVUs for 11426PPRRVU2026_Oct_nonQPP.csv, line 1,320 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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