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

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 Nebraska, Medicare pays $474.09 for 11646 in the office and $305.76 when it’s performed in a hospital or facility.

$474.09Office (non-facility)
$305.76Hospital or facility
−8.0%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 Nebraska
  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 Nebraska 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. Nebraska pays $474.09. The RVUs are the same everywhere; the geographic indexes change the dollars.

11646 in Nebraska vs other payment areas
  1. Nebraska · this page$474.09
  2. Los Angeles, CA · California$564.29+$90.20
  3. Washington, DC area · District of Columbia$579.79+$105.70
  4. Miami, FL · Florida$575.37+$101.28
  5. Chicago, IL · Illinois$559.29+$85.20
  6. Manhattan, NY · New York$592.35+$118.26
  7. Alaska · Alaska$621.19+$147.10

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

Every other payment area

11646 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$466.62$307.04
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

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 Nebraska 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

72

Locality
Nebraska
Physician work
1.000
Practice expense
0.923
Malpractice
0.378
Office calculation for 11646 in Nebraska
ComponentRVULocality factorAdjusted
Physician work6.10× 1.0006.1000
Practice expense8.38× 0.9237.7347
Malpractice0.95× 0.3780.3591
Total RVUs14.1938
Conversion factor× 33.4009

Office rate, Nebraska$474.09

Office: (6.1 × 1 + 8.38 × 0.923 + 0.95 × 0.378) × $33.4009 = $474.09

Facility: (6.1 × 1 + 2.92 × 0.923 + 0.95 × 0.378) × $33.4009 = $305.76

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, Nebraska
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.$362.69
11643Malignant lesion excision, face, ears, eyelids, nose, lipsSame sites; applies when the excised diameter is 2.1 to 3 cm.$292.38
11606Lesion excision, trunk or extremity, over 4 cmLarge malignant-lesion excision code for trunk, arms, or legs.$425.19
11626Skin excision, scalp, neck, hands, feet, genitalia; over 4 cmLarge malignant-lesion excision code for scalp, neck, hands, feet, or genitalia.$384.62
Used instead
17311Mohs surgery, first stage, head/neck/hands/feet/genitaliaMohs surgery may be used instead when staged microscopic margin examination is performed.$620.48

How 11646 has changed in Nebraska

11646 · Office / nonfacility

$474.09

Effective 2026-10-01

The base rate is $26.65 higher than on 2025-10-01, moving from $447.44 to $474.09 (6.0%).

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

    $447.44changed to$474.09

    • 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
    • Practice expense GPCI 0.917 changed to 0.923
    • Malpractice GPCI 0.304 changed to 0.378

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $460.15changed to$447.44

    • 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

    $452.64changed to$460.15

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $465.61changed to$452.64

    • 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
    • Practice expense GPCI 0.913 changed to 0.917
    • Malpractice GPCI 0.269 changed to 0.304

  5. January 1, 2023

    RVU23A

    $469.14changed to$465.61

    • 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
    • Practice expense GPCI 0.908 changed to 0.913
    • Malpractice GPCI 0.235 changed to 0.269

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $471.92changed to$469.14

    • 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

    $477.78changed to$471.92

    • 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
    • Practice expense GPCI 0.909 changed to 0.908
    • Malpractice GPCI 0.277 changed to 0.235

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $478.24changed to$477.78

    • 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
    • Practice expense GPCI 0.910 changed to 0.909
    • Malpractice GPCI 0.318 changed to 0.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $478.59changed to$478.24

    • 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

    $477.46changed to$478.59

    • 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
    • Practice expense GPCI 0.909 changed to 0.910
    • Malpractice GPCI 0.340 changed to 0.318

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $476.57changed to$477.46

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.35 changed to 7.36
    • Practice expense GPCI 0.908 changed to 0.909
    • Malpractice GPCI 0.362 changed to 0.340

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $478.02changed to$476.57

    • 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

    $475.65changed to$478.02

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $471.80changed to$475.65

    • 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
    • Practice expense GPCI 0.906 changed to 0.908
    • Malpractice GPCI 0.342 changed to 0.362

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $471.77changed to$471.80

    • 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
    • Practice expense GPCI 0.904 changed to 0.906
    • Malpractice GPCI 0.322 changed to 0.342

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $471.77

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$474.09$305.76RVU26D
2026-07-01$474.09$305.76RVU26C
2026-04-01$474.09$305.76RVU26B
2026-01-01$474.09$305.76RVU26A
2025-10-01$447.44$343.33RVU25D
2025-07-01$447.44$343.33RVU25C
2025-04-01$447.44$343.33RVU25B
2025-01-01$447.44$343.33RVU25A
2024-10-01$460.15$351.49RVU24D
2024-07-01$460.15$351.49RVU24C
2024-04-01$460.15$351.49RVU24B
2024-03-09$460.15$351.49RVU24AR
2024-01-01$452.64$345.75RVU24A
2023-10-01$465.61$355.47RVU23D
2023-07-01$465.61$355.47RVU23C
2023-04-01$465.61$355.47RVU23B
2023-01-01$465.61$355.47RVU23A
2022-10-01$469.14$357.91RVU22D
2022-07-01$469.14$357.91RVU22C
2022-04-01$469.14$357.91RVU22B
2022-01-01$469.14$357.91RVU22A
2021-10-01$471.92$359.44RVU21D
2021-07-01$471.92$359.44RVU21C
2021-04-01$471.92$359.44RVU21B
2021-01-01$471.92$359.44RVU21A
2020-10-01$477.78$369.85RVU20D
2020-07-01$477.78$369.85RVU20C
2020-04-01$477.78$369.85RVU20B
2020-01-01$477.78$369.85RVU20A
2019-10-01$478.24$371.66RVU19D
2019-07-01$478.24$371.66RVU19C
2019-04-01$478.24$371.66RVU19B
2019-01-01$478.24$371.66RVU19A
2018-10-01$478.59$371.14RVU18D
2018-07-01$478.59$371.14RVU18C
2018-04-01$478.59$371.14RVU18B
2018-01-01$478.59$371.14RVU18AR1
2017-10-01$477.46$371.76RVU17D
2017-07-01$477.46$371.76RVU17C
2017-04-01$477.46$371.76RVU17B
2017-01-01$477.46$371.76RVU17A
2016-10-01$476.57$371.23RVU16D
2016-07-01$476.57$371.23RVU16C
2016-04-01$476.57$371.23RVU16B
2016-01-01$476.57$371.23RVU16A
2015-10-01$478.02$371.66RVU15D
2015-07-01$478.02$371.66RVU15C
2015-04-01$475.65$369.81RVU15B
2015-01-01$475.65$369.81RVU15A
2014-10-01$471.80$368.60RVU14D
2014-07-01$471.80$368.60RVU14C
2014-04-01$471.80$368.60RVU14B
2014-01-01$471.80$368.60RVU14A
2013-10-01$471.77$360.74RVU13D
2013-07-01$471.77$360.74RVU13C
2013-04-01$471.77$360.74RVU13B
2013-01-01$471.77$360.74RVU13AR

Price 11646 for an earlier date of service

Where the Nebraska rate applies

Nebraska is a Medicare payment area, not a city. Our Census mapping connects it to 593 cities and communities in Nebraska. Some span more than one payment area; confirm with the service ZIP.

  • Abie
  • Adams
  • Agnew
  • Ainsworth
  • Albion
  • Alda
  • Alexandria
  • Allen

Browse all communities in Nebraska

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 NebraskaGPCI2026.csv, line 72 (RVU26D)

Open CMS sourceHow we calculate rates

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