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CPT code 11446: Skin lesion excision, face, over 4 cm2026 Medicare rate & RVUs in Virginia

Reports excision of a benign lesion on the face or related facial sites when the lesion and required margins together exceed 4 cm.

CMS RVU26DEffective Oct 1, 2026One payment locality1K Medicare services in 2024

In Virginia, Medicare pays $388.06 for 11446 in the office and $274.13 when it’s performed in a hospital or facility.

$388.06Office (non-facility)
$274.13Hospital or facility
−2.6%vs the national office rate ($398.47)

Check a contract rate as a % of Medicare · 11446 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 11446 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 11446 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 11446 covers

A clinician surgically removes a benign skin lesion from the face, ear, eyelid, nose, lip, or mucous membrane. Dermatologists, plastic surgeons, and other surgeons may perform the procedure in an office or operating-room setting. The code represents a large excision in these facial locations, not a shave or destruction technique.

Choose the size level using the widest diameter of the lesion plus the margins removed; the combined excised diameter must be greater than 4 cm. Document the site, benign diagnosis, lesion size, and margins so the measured excision size is clear. Simple closure is included; a separately documented intermediate or complex repair may be reported when its criteria are met. Related postoperative visits during the 10-day global period are included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, 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 Virginia compares for 11446

Across 109 of 109 payment localities, the office rate for 11446 runs from $356.52 in Arkansas to $502.12 in San Benito County, CA. Virginia pays $388.06. The RVUs are the same everywhere; the geographic indexes change the dollars.

11446 in Virginia vs other payment areas
  1. Virginia · this page$388.06
  2. Los Angeles, CA · California$437.41+$49.35
  3. Washington, DC area · District of Columbia$448.54+$60.48
  4. Miami, FL · Florida$442.20+$54.14
  5. Chicago, IL · Illinois$430.08+$42.02
  6. Manhattan, NY · New York$457.34+$69.28
  7. Alaska · Alaska$480.70+$92.64

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

Every other payment area

11446 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$361.18$259.77
ArkansasArkansas$356.52$256.96
ArizonaArizona$388.40$276.09
Bakersfield, CACalifornia$413.63$286.60
Chico, CACalifornia$411.66$284.63
El Centro, CACalifornia$411.77$284.74
Fresno, CACalifornia$411.66$284.63
Hanford, CACalifornia$411.66$284.63

11446 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.

$356.52

$480.70

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

View every state and territory as a table
11446 office rate range by state
State / territoryOffice rate rangeLocalities
AK$480.701
AL$361.181
AR$356.521
AZ$388.401
CA$411.66–$502.1229
CO$409.421
CT$423.271
DC$448.541
DE$394.331
FL$400.24–$442.203
GA$379.13–$407.022
GU$418.971
HI$418.971
IA$366.121
ID$368.951
IL$392.17–$430.084
IN$370.781
KS$366.141
KY$372.181
LA$372.28–$388.612
MA$407.99–$444.962
MD$400.81–$448.543
ME$372.33–$388.122
MI$382.31–$406.372
MN$388.851
MO$367.60–$387.983
MS$362.041
MT$398.431
NC$375.571
ND$384.981
NE$367.451
NH$404.631
NJ$427.12–$444.982
NM$384.821
NV$394.901
NY$380.75–$469.425
OH$379.561
OK$369.931
OR$390.85–$419.522
PA$379.23–$414.672
PR$400.551
RI$406.231
SC$378.391
SD$383.391
TN$367.991
TX$377.11–$408.928
UT$382.991
VA$388.06–$448.542
VI$400.551
VT$385.061
WA$406.71–$451.952
WI$373.541
WV$379.511
WY$392.571

See 11446 in every payment locality

How the 11446 rate is calculated

Each of 11446’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 · 11446

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.68

4.68 RVUs× 1.000 GPCI

Practice expense6.57

6.57 RVUs× 1.000 GPCI

Malpractice0.68

0.68 RVUs× 1.000 GPCI

Adjusted RVUs

11.9300

Conversion factor

$33.4009

Medicare rate

$398.47

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

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,326

Code
11446
Physician work
4.68
Practice expense
6.57
Malpractice
0.68

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 11446 in Virginia
ComponentRVULocality factorAdjusted
Physician work4.68× 1.0004.6800
Practice expense6.57× 0.9836.4583
Malpractice0.68× 0.7060.4801
Total RVUs11.6184
Conversion factor× 33.4009

Office rate, Virginia$388.06

Office: (4.68 × 1 + 6.57 × 0.983 + 0.68 × 0.706) × $33.4009 = $388.06

Facility: (4.68 × 1 + 3.1 × 0.983 + 0.68 × 0.706) × $33.4009 = $274.13

Open 11446 in the RVU calculator

Payment rules and modifiers for 11446

11446 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 11446

Skin lesion excision, face, over 4 cm

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 · 11446

Skin lesion excision, face, over 4 cm

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

11446 without 51 · national office

$398.47

Skin lesion excision, face, over 4 cm

11446-51 · Second procedure: 50%

$199.24

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 11446

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

Codes related to 11446
CodeHow it relatesOffice range, Virginia
Same family
11444Skin excision, face, 3.1–4 cmFacial-site benign excision when lesion plus margins measures 3.1 to 4 cm.$281.14
11440Lesion excision, face, 0.5 cm or lessFacial-site benign excision at the smallest size level.$139.10
11426Benign lesion excision, scalp, neck, hands, feet, genitaliaBenign excision over 4 cm at the scalp, neck, hands, feet, or genitalia.$330.59
Used instead
11646Malignant lesion excision, face and related sites, over 4 cmFacial-site excision over 4 cm when the lesion is malignant rather than benign.$501.29

How 11446 has changed in Virginia

11446 · Office / nonfacility

$388.06

Effective 2026-10-01

The base rate is $19.89 higher than on 2025-10-01, moving from $368.17 to $388.06 (5.4%).

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

    $368.17changed to$388.06

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.80 changed to 4.68
    • Practice expense RVU 6.15 changed to 6.57
    • Malpractice RVU 0.69 changed to 0.68
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $376.67changed to$368.17

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.09 changed to 6.15
    • Malpractice RVU 0.68 changed to 0.69

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $370.52changed to$376.67

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $382.48changed to$370.52

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.01 changed to 6.09
    • Malpractice RVU 0.65 changed to 0.68
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $393.88changed to$382.48

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.02 changed to 6.01
    • Malpractice RVU 0.66 changed to 0.65
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $396.46changed to$393.88

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.00 changed to 6.02

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $397.82changed to$396.46

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.66 changed to 6.00
    • Malpractice RVU 0.68 changed to 0.66
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $396.82changed to$397.82

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.59 changed to 5.66
    • Malpractice RVU 0.77 changed to 0.68
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $395.68changed to$396.82

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.57 changed to 5.59

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $392.04changed to$395.68

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.54 changed to 5.57
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $388.80changed to$392.04

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.51 changed to 5.54
    • Malpractice RVU 0.78 changed to 0.77
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $389.91changed to$388.80

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.77 changed to 0.78

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $387.97changed to$389.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $384.39changed to$387.97

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.44 changed to 5.51
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $381.65changed to$384.39

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.97 changed to 5.44
    • Malpractice RVU 0.80 changed to 0.77
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $381.65

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$388.06$274.13RVU26D
2026-07-01$388.06$274.13RVU26C
2026-04-01$388.06$274.13RVU26B
2026-01-01$388.06$274.13RVU26A
2025-10-01$368.17$304.83RVU25D
2025-07-01$368.17$304.83RVU25C
2025-04-01$368.17$304.83RVU25B
2025-01-01$368.17$304.83RVU25A
2024-10-01$376.67$309.85RVU24D
2024-07-01$376.67$309.85RVU24C
2024-04-01$376.67$309.85RVU24B
2024-03-09$376.67$309.85RVU24AR
2024-01-01$370.52$304.79RVU24A
2023-10-01$382.48$313.70RVU23D
2023-07-01$382.48$313.70RVU23C
2023-04-01$382.48$313.70RVU23B
2023-01-01$382.48$313.70RVU23A
2022-10-01$393.88$321.92RVU22D
2022-07-01$393.88$321.92RVU22C
2022-04-01$393.88$321.92RVU22B
2022-01-01$393.88$321.92RVU22A
2021-10-01$396.46$323.89RVU21D
2021-07-01$396.46$323.89RVU21C
2021-04-01$396.46$323.89RVU21B
2021-01-01$396.46$323.89RVU21A
2020-10-01$397.82$330.58RVU20D
2020-07-01$397.82$330.58RVU20C
2020-04-01$397.82$330.58RVU20B
2020-01-01$397.82$330.58RVU20A
2019-10-01$396.82$331.79RVU19D
2019-07-01$396.82$331.79RVU19C
2019-04-01$396.82$331.79RVU19B
2019-01-01$396.82$331.79RVU19A
2018-10-01$395.68$331.79RVU18D
2018-07-01$395.68$331.79RVU18C
2018-04-01$395.68$331.79RVU18B
2018-01-01$395.68$331.79RVU18AR1
2017-10-01$392.04$330.17RVU17D
2017-07-01$392.04$330.17RVU17C
2017-04-01$392.04$330.17RVU17B
2017-01-01$392.04$330.17RVU17A
2016-10-01$388.80$327.21RVU16D
2016-07-01$388.80$327.21RVU16C
2016-04-01$388.80$327.21RVU16B
2016-01-01$388.80$327.21RVU16A
2015-10-01$389.91$327.39RVU15D
2015-07-01$389.91$327.39RVU15C
2015-04-01$387.97$325.76RVU15B
2015-01-01$387.97$325.76RVU15A
2014-10-01$384.39$324.01RVU14D
2014-07-01$384.39$324.01RVU14C
2014-04-01$384.39$324.01RVU14B
2014-01-01$384.39$324.01RVU14A
2013-10-01$381.65$316.83RVU13D
2013-07-01$381.65$316.83RVU13C
2013-04-01$381.65$316.83RVU13B
2013-01-01$381.65$316.83RVU13AR

Price 11446 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

11446 billing questions

How is the size selected for this code?

Use the widest diameter of the lesion plus the margins removed, not the lesion measurement alone. The combined excised diameter must be greater than 4 cm.

When should 11444 be used instead?

Use 11444 for an excision on the same facial sites when the lesion plus margins measures 3.1 to 4 cm. A measurement over 4 cm supports 11446.

Is closure separately billable?

Simple closure is included in the excision. A distinct intermediate or complex repair may be reported separately when performed and supported by the repair documentation.

Can modifier 50 be appended for lesions on both sides?

No. The descriptor and anatomy make modifier 50 inappropriate for this code.

What postoperative care is included?

Related postoperative visits for 10 days are included in the global period. Document and evaluate separate services under the applicable reporting rules.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery reporting are not permitted.

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 11446PPRRVU2026_Oct_nonQPP.csv, line 1,326 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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