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CPT code 11646: Malignant lesion excision, face and related sites, over 4 cm2026 Medicare rate & RVUs in Washington, DC area

Reports surgical removal of a malignant skin lesion on the face or related sites when the excised diameter, including margins, exceeds 4 cm.

CMS RVU26DEffective Oct 1, 2026One payment locality6.9K Medicare services in 2024

In Washington, DC area, Medicare pays $579.79 for 11646 in the office and $364.96 when it’s performed in a hospital or facility.

$579.79Office (non-facility)
$364.96Hospital or facility
+12.5%vs the national office rate ($515.38)

Check a contract rate as a % of Medicare · 11646 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 11646 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 11646 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 11646 covers

This code covers excision of a malignant skin lesion from the face, ear, eyelid, nose, or lip, with the surrounding margin of tissue. Dermatologists, plastic surgeons, and other qualified surgeons may perform it in an office or outpatient surgical setting. It describes excision rather than Mohs micrographic surgery, which uses a separate technique and code family.

Select the code by anatomical site and the diameter of the excised area, including margins—not the visible lesion alone. Document the lesion dimensions, margins taken, final excised diameter, site, and malignancy. Simple closure is included; a separately documented intermediate or complex repair may be reported when appropriate. CMS assigns a 10-day global period, including related postoperative visits during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery, and does not permit co-surgeons or team surgery for this service.

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 Washington, DC area compares for 11646

Across 109 of 109 payment localities, the office rate for 11646 runs from $460.52 in Arkansas to $646.78 in San Benito County, CA. Washington, DC area pays $579.79. The RVUs are the same everywhere; the geographic indexes change the dollars.

11646 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$579.79
  2. Los Angeles, CA · California$564.29−$15.50
  3. Miami, FL · Florida$575.37−$4.42
  4. Chicago, IL · Illinois$559.29−$20.50
  5. Manhattan, NY · New York$592.35+$12.56
  6. Alaska · Alaska$621.19+$41.40
  7. Alabama · Alabama$466.62−$113.17

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

11646 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$460.52$303.87
ArizonaArizona$502.13$325.41
Bakersfield, CACalifornia$533.71$333.83
Chico, CACalifornia$530.99$331.11
El Centro, CACalifornia$531.15$331.27
Fresno, CACalifornia$530.99$331.11
Hanford, CACalifornia$530.99$331.11
Madera, CACalifornia$530.99$331.11

11646 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.

$460.52

$621.19

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

View every state and territory as a table
11646 office rate range by state
State / territoryOffice rate rangeLocalities
AK$621.191
AL$466.621
AR$460.521
AZ$502.131
CA$530.99–$646.7829
CO$528.791
CT$547.671
DC$579.791
DE$509.831
FL$519.02–$575.373
GA$491.24–$526.842
GU$540.361
HI$540.361
IA$472.451
ID$476.261
IL$508.89–$559.294
IN$478.631
KS$472.771
KY$481.611
LA$481.85–$503.182
MA$527.03–$574.542
MD$518.17–$579.793
ME$480.99–$501.152
MI$495.12–$527.352
MN$501.151
MO$475.92–$502.003
MS$468.191
MT$515.311
NC$485.171
ND$496.531
NE$474.091
NH$522.891
NJ$552.35–$575.152
NM$498.521
NV$510.361
NY$491.96–$608.515
OH$491.281
OK$478.351
OR$504.83–$541.582
PA$490.68–$536.642
PR$517.981
RI$525.061
SC$489.341
SD$494.311
TN$475.211
TX$487.93–$528.408
UT$495.351
VA$501.29–$579.792
VI$517.981
VT$496.901
WA$525.28–$583.292
WI$481.661
WV$492.391
WY$507.131

See 11646 in every payment locality

How the 11646 rate is calculated

Each of 11646’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 · 11646

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.10

6.10 RVUs× 1.000 GPCI

Practice expense8.38

8.38 RVUs× 1.000 GPCI

Malpractice0.95

0.95 RVUs× 1.000 GPCI

Adjusted RVUs

15.4300

Conversion factor

$33.4009

Medicare rate

$515.38

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

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,358

Code
11646
Physician work
6.10
Practice expense
8.38
Malpractice
0.95

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 11646 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work6.10× 1.0546.4294
Practice expense8.38× 1.1789.8716
Malpractice0.95× 1.1131.0574
Total RVUs17.3584
Conversion factor× 33.4009

Office rate, Washington, DC area$579.79

Office: (6.1 × 1.054 + 8.38 × 1.178 + 0.95 × 1.113) × $33.4009 = $579.79

Facility: (6.1 × 1.054 + 2.92 × 1.178 + 0.95 × 1.113) × $33.4009 = $364.96

Open 11646 in the RVU calculator

Payment rules and modifiers for 11646

11646 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 11646

Malignant lesion excision, face and related sites, 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 · 11646

Malignant lesion excision, face and related sites, 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

11646 without 51 · national office

$515.38

Malignant lesion excision, face and related sites, over 4 cm

11646-51 · Second procedure: 50%

$257.69

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 11646

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

Codes related to 11646
CodeHow it relatesOffice range, Washington, DC area
Same family
11644Malignant lesion excision, face and related sites, 3.1-4 cmSame sites; applies when the excised diameter is 3.1 to 4 cm.$443.91
11643Malignant lesion excision, face, ears, eyelids, nose, lipsSame sites; applies when the excised diameter is 2.1 to 3 cm.$357.49
11606Lesion excision, trunk or extremity, over 4 cmLarge malignant-lesion excision code for trunk, arms, or legs.$524.05
11626Skin excision, scalp, neck, hands, feet, genitalia; over 4 cmLarge malignant-lesion excision code for scalp, neck, hands, feet, or genitalia.$473.55
Used instead
17311Mohs surgery, first stage, head/neck/hands/feet/genitaliaMohs surgery may be used instead when staged microscopic margin examination is performed.$759.41

How 11646 has changed in Washington, DC area

11646 · Office / nonfacility

$579.79

Effective 2026-10-01

The base rate is $22.60 higher than on 2025-10-01, moving from $557.19 to $579.79 (4.1%).

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

    $557.19changed to$579.79

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 6.26 changed to 6.10
    • Practice expense RVU 7.93 changed to 8.38
    • Malpractice RVU 0.99 changed to 0.95
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $573.00changed to$557.19

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.92 changed to 7.93

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $563.65changed to$573.00

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $589.47changed to$563.65

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.91 changed to 7.92
    • Malpractice RVU 0.96 changed to 0.99
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $604.08changed to$589.47

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.79 changed to 7.91
    • Malpractice RVU 0.95 changed to 0.96
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $606.89changed to$604.08

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.76 changed to 7.79
    • Malpractice RVU 0.93 changed to 0.95

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $605.01changed to$606.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.40 changed to 7.76
    • Malpractice RVU 0.91 changed to 0.93
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $601.78changed to$605.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.34 changed to 7.40
    • Malpractice RVU 1.04 changed to 0.91
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $601.96changed to$601.78

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.37 changed to 7.34
    • Malpractice RVU 1.03 changed to 1.04

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $601.18changed to$601.96

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.36 changed to 7.37
    • Malpractice RVU 1.04 changed to 1.03
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $600.34changed to$601.18

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.35 changed to 7.36
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $601.58changed to$600.34

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 1.02 changed to 1.04

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $598.59changed to$601.58

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $590.81changed to$598.59

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.25 changed to 7.35
    • Malpractice RVU 1.00 changed to 1.02
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $591.50changed to$590.81

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.04 changed to 7.25
    • Malpractice RVU 1.05 changed to 1.00
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $591.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$579.79$364.96RVU26D
2026-07-01$579.79$364.96RVU26C
2026-04-01$579.79$364.96RVU26B
2026-01-01$579.79$364.96RVU26A
2025-10-01$557.19$421.86RVU25D
2025-07-01$557.19$421.86RVU25C
2025-04-01$557.19$421.86RVU25B
2025-01-01$557.19$421.86RVU25A
2024-10-01$573.00$431.75RVU24D
2024-07-01$573.00$431.75RVU24C
2024-04-01$573.00$431.75RVU24B
2024-03-09$573.00$431.75RVU24AR
2024-01-01$563.65$424.70RVU24A
2023-10-01$589.47$443.01RVU23D
2023-07-01$589.47$443.01RVU23C
2023-04-01$589.47$443.01RVU23B
2023-01-01$589.47$443.01RVU23A
2022-10-01$604.08$452.66RVU22D
2022-07-01$604.08$452.66RVU22C
2022-04-01$604.08$452.66RVU22B
2022-01-01$604.08$452.66RVU22A
2021-10-01$606.89$453.79RVU21D
2021-07-01$606.89$453.79RVU21C
2021-04-01$606.89$453.79RVU21B
2021-01-01$606.89$453.79RVU21A
2020-10-01$605.01$460.04RVU20D
2020-07-01$605.01$460.04RVU20C
2020-04-01$605.01$460.04RVU20B
2020-01-01$605.01$460.04RVU20A
2019-10-01$601.78$460.64RVU19D
2019-07-01$601.78$460.64RVU19C
2019-04-01$601.78$460.64RVU19B
2019-01-01$601.78$460.64RVU19A
2018-10-01$601.96$459.68RVU18D
2018-07-01$601.96$459.68RVU18C
2018-04-01$601.96$459.68RVU18B
2018-01-01$601.96$459.68RVU18AR1
2017-10-01$601.18$461.06RVU17D
2017-07-01$601.18$461.06RVU17C
2017-04-01$601.18$461.06RVU17B
2017-01-01$601.18$461.06RVU17A
2016-10-01$600.34$460.55RVU16D
2016-07-01$600.34$460.55RVU16C
2016-04-01$600.34$460.55RVU16B
2016-01-01$600.34$460.55RVU16A
2015-10-01$601.58$460.43RVU15D
2015-07-01$601.58$460.43RVU15C
2015-04-01$598.59$458.14RVU15B
2015-01-01$598.59$458.14RVU15A
2014-10-01$590.81$453.88RVU14D
2014-07-01$590.81$453.88RVU14C
2014-04-01$590.81$453.88RVU14B
2014-01-01$590.81$453.88RVU14A
2013-10-01$591.50$444.35RVU13D
2013-07-01$591.50$444.35RVU13C
2013-04-01$591.50$444.35RVU13B
2013-01-01$591.50$444.35RVU13AR

Price 11646 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

11646 billing questions

When should 11646 be selected instead of 11644?

Use 11646 for an excised diameter greater than 4 cm at the face, ear, eyelid, nose, or lip. Code 11644 covers the same sites when the excised diameter is 3.1 to 4 cm.

Is the measurement based on the visible lesion?

No. Select the size level using the excised diameter, including the margins. Document the lesion size, margin taken, and resulting excised diameter.

Can the repair be billed separately?

Simple closure is included. A separately documented intermediate or complex repair may be reported when the repair meets the requirements for that service.

Does modifier 50 apply to lesions on both sides of the face?

No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.

How are other procedures in the same session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Related postoperative visits are included in this code's 10-day global period.

Can an assistant or co-surgeon be billed for this excision?

CMS does not pay an assistant at surgery for this code and does not permit co-surgeons or team surgery.

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 11646PPRRVU2026_Oct_nonQPP.csv, line 1,358 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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