Billing code 11463: Hidradenitis excisionMedicare rate & RVUs
Reports excision of hidradenitis-affected skin and subcutaneous tissue in the inguinal region when the wound requires complex repair.
Medicare pays $574.16 for 11463 nationally in the office and $315.64 in a hospital or facility. Local office rates run $503.44–$753.41.
Medicare rate · 11463
Hidradenitis excision
Swap in your local Medicare rate.
- Work RVUs
- 4.32
- Total RVUs
- 17.19
- Global days
- 090
National rate · 2026
$574.16
Office setting, before claim adjustments.
See every locality for 11463 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 11463 covers
Code 11463 describes surgical removal of affected skin and subcutaneous tissue for hidradenitis in the groin, with complex repair of the resulting wound. A typical case involves chronic, recurrent disease with involved nodules or sinus tracts in the inguinal fold, rather than drainage of a single acute abscess. Dermatologic, general, or plastic surgeons may perform the procedure in an office or outpatient surgical setting.
Select this code when the site is inguinal and the repair meets the complex level; the extent of excision alone does not determine the repair level. Document the location, tissue removed, disease extent, and work supporting complex closure. The repair is included in the code and is not separately reported. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple procedures, the highest-valued procedure is paid in full and others at 50%. Modifier 50 bilateral payment is 150%; assistant-at-surgery payment requires documented medical necessity. Co-surgeons and team surgery 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 11463 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$503.44 to $753.41
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $511.35 | $285.14 |
| Alaska* | $659.14 | $383.81 |
| Arizona | $557.51 | $307.01 |
| Arkansas | $503.44 | $281.37 |
| Atlanta | $586.91 | $324.25 |
| Austin | $594.33 | $320.81 |
| Bakersfield | $603.86 | $320.52 |
| Baltimore/Surr. Cntys | $612.67 | $335.28 |
| Beaumont | $536.03 | $300.78 |
| Brazoria | $565.25 | $309.05 |
| Chicago | $615.24 | $355.42 |
| Chico | $601.42 | $318.08 |
| Colorado | $595.09 | $320.02 |
| Connecticut | $614.06 | $335.63 |
| Dallas | $569.68 | $312.20 |
| Dc + Md/Va Suburbs | $656.56 | $352.02 |
| Delaware | $567.11 | $311.69 |
| Detroit | $580.31 | $330.83 |
| East St. Louis | $571.93 | $334.09 |
| El Centro | $601.57 | $318.23 |
| Fort Lauderdale | $603.12 | $341.23 |
| Fort Worth | $566.06 | $311.16 |
| Fresno | $601.42 | $318.08 |
| Galveston | $567.46 | $310.74 |
| Hanford-Corcoran | $601.42 | $318.08 |
| Hawaii, Guam | $616.65 | $322.71 |
| Houston | $583.56 | $326.85 |
| Idaho | $526.63 | $288.79 |
| Indiana | $529.82 | $290.17 |
| Iowa | $522.40 | $285.85 |
| Kansas | $521.14 | $287.43 |
| Kentucky | $527.21 | $297.38 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $643.49 | $337.66 |
| Madera | $601.42 | $318.08 |
| Manhattan | $665.50 | $365.09 |
| Merced | $601.42 | $318.08 |
| Metropolitan Boston | $654.54 | $345.86 |
| Metropolitan Kansas City | $549.06 | $306.30 |
| Metropolitan Philadelphia | $598.85 | $329.73 |
| Metropolitan St. Louis | $555.00 | $308.88 |
| Miami | $635.52 | $366.40 |
| Minnesota | $565.08 | $299.06 |
| Mississippi | $510.82 | $288.24 |
| Modesto | $601.42 | $318.08 |
| Montana** | $574.10 | $315.58 |
| Napa | $696.14 | $355.41 |
| Nebraska | $525.04 | $286.43 |
| Nevada** | $569.65 | $310.87 |
| New Hampshire | $586.91 | $317.78 |
| New Mexico | $546.83 | $309.76 |
| New Orleans | $554.53 | $311.26 |
| North Carolina | $536.72 | $295.52 |
| North Dakota** | $556.70 | $298.18 |
| Northern Nj | $649.33 | $349.44 |
| Nyc Suburbs/Long Island | $684.28 | $376.89 |
| Ohio | $539.56 | $303.52 |
| Oklahoma | $524.76 | $293.89 |
| Oxnard-Thousand Oaks-Ventura | $640.01 | $334.43 |
| Portland | $613.40 | $326.18 |
| Poughkpsie/N Nyc Suburbs | $624.87 | $341.79 |
| Puerto Rico | $578.13 | $316.76 |
| Queens | $669.27 | $363.70 |
| Redding | $601.42 | $318.08 |
| Rest Of California | $601.42 | $318.08 |
| Rest Of Florida | $571.33 | $324.18 |
| Rest Of Georgia | $536.55 | $305.95 |
| Rest Of Illinois | $555.87 | $319.84 |
| Rest Of Louisiana | $526.87 | $298.08 |
| Rest Of Maine | $531.01 | $293.17 |
| Rest Of Maryland | $578.00 | $316.37 |
| Rest Of Massachusetts | $591.73 | $319.50 |
| Rest Of Michigan | $543.11 | $307.08 |
| Rest Of Missouri | $518.13 | $295.28 |
| Rest Of New Jersey | $619.63 | $337.32 |
| Rest Of New York | $545.41 | $299.81 |
| Rest Of Oregon | $563.83 | $306.34 |
| Rest Of Pennsylvania | $539.71 | $302.38 |
| Rest Of Texas | $550.89 | $305.55 |
| Rest Of Washington | $590.24 | $318.01 |
| Rhode Island | $586.94 | $319.89 |
| Riverside-San Bernardino-Ontario | $610.88 | $327.54 |
| Sacramento-Roseville-Folsom | $631.00 | $330.33 |
| Salinas | $628.67 | $329.04 |
| San Diego-Chula Vista-Carlsbad | $643.52 | $334.33 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $736.16 | $371.65 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $735.16 | $370.65 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $753.41 | $380.62 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $749.32 | $376.53 |
| San Luis Obispo-Paso Robles | $618.64 | $324.18 |
| Santa Cruz-Watsonville | $649.66 | $335.55 |
| Santa Maria-Santa Barbara | $631.04 | $329.60 |
| Santa Rosa-Petaluma | $656.16 | $338.69 |
| Seattle (King Cnty) | $666.91 | $349.70 |
| South Carolina | $539.32 | $300.44 |
| South Dakota** | $554.64 | $296.12 |
| Southern Maine | $559.71 | $303.51 |
| Stockton | $601.42 | $318.08 |
| Suburban Chicago | $608.68 | $343.17 |
| Tennessee | $524.11 | $289.11 |
| Utah | $547.13 | $304.12 |
| Vallejo | $694.70 | $353.97 |
| Vermont | $555.64 | $299.70 |
| Virgin Islands | $578.13 | $316.76 |
| Virginia | $558.71 | $304.58 |
| Visalia | $601.42 | $318.08 |
| West Virginia | $534.37 | $309.71 |
| Wisconsin | $537.00 | $289.34 |
| Wyoming** | $566.52 | $308.00 |
| Yuba City | $601.42 | $318.08 |
11463 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$503.44
$677.42
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $659.14 | 1 |
| AL | $511.35 | 1 |
| AR | $503.44 | 1 |
| AZ | $557.51 | 1 |
| CA | $601.42–$753.41 | 29 |
| CO | $595.09 | 1 |
| CT | $614.06 | 1 |
| DC | $656.56 | 1 |
| DE | $567.11 | 1 |
| FL | $571.33–$635.52 | 3 |
| GA | $536.55–$586.91 | 2 |
| GU | $616.65 | 1 |
| HI | $616.65 | 1 |
| IA | $522.40 | 1 |
| ID | $526.63 | 1 |
| IL | $555.87–$615.24 | 4 |
| IN | $529.82 | 1 |
| KS | $521.14 | 1 |
| KY | $527.21 | 1 |
| LA | $526.87–$554.53 | 2 |
| MA | $591.73–$654.54 | 2 |
| MD | $578.00–$656.56 | 3 |
| ME | $531.01–$559.71 | 2 |
| MI | $543.11–$580.31 | 2 |
| MN | $565.08 | 1 |
| MO | $518.13–$555.00 | 3 |
| MS | $510.82 | 1 |
| MT | $574.10 | 1 |
| NC | $536.72 | 1 |
| ND | $556.70 | 1 |
| NE | $525.04 | 1 |
| NH | $586.91 | 1 |
| NJ | $619.63–$649.33 | 2 |
| NM | $546.83 | 1 |
| NV | $569.65 | 1 |
| NY | $545.41–$684.28 | 5 |
| OH | $539.56 | 1 |
| OK | $524.76 | 1 |
| OR | $563.83–$613.40 | 2 |
| PA | $539.71–$598.85 | 2 |
| PR | $578.13 | 1 |
| RI | $586.94 | 1 |
| SC | $539.32 | 1 |
| SD | $554.64 | 1 |
| TN | $524.11 | 1 |
| TX | $536.03–$594.33 | 8 |
| UT | $547.13 | 1 |
| VA | $558.71–$656.56 | 2 |
| VI | $578.13 | 1 |
| VT | $555.64 | 1 |
| WA | $590.24–$666.91 | 2 |
| WI | $537.00 | 1 |
| WV | $534.37 | 1 |
| WY | $566.52 | 1 |
How the 11463 rate is calculated
Each of 11463’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 · 11463
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.32Practice expense 11.99Malpractice 0.88
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11463
11463 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11463
Hidradenitis excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 11463
Hidradenitis excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
11463 without 50 · national office
$574.16
Hidradenitis excision
11463-50 · Bilateral: 150%
$861.24
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
11463 compared with similar codes
Compare codes
11463 vs 11462 vs 11451 vs 11471: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11462Hidradenitis excision
- Both apply to inguinal hidradenitis excision. Choose 11463 for complex repair and 11462 for simple or intermediate repair.
- 11451Axillary hidradenitis excision
- Both describe complex-repair hidradenitis excision, but 11451 is for the axillary site; 11463 is for the inguinal site.
- 11471Hidradenitis excision
- Both describe complex-repair hidradenitis excision, but 11471 is for perianal, perineal, or umbilical sites; 11463 is inguinal.
11463 billing questions
When should 11463 be chosen over 11462?
Both codes describe inguinal hidradenitis excision. Use 11463 when the wound requires complex repair; use 11462 when the repair is simple or intermediate.
Can the complex repair be billed separately?
No. The complex repair is included in 11463, so do not report a separate repair code for closing the excision wound.
What documentation supports the complex repair level?
Document the inguinal site, the diseased tissue removed, and the closure work that supports a complex repair. The size of the excision by itself does not establish that level.
How is bilateral inguinal treatment reported?
CMS lists bilateral payment with modifier 50 at 150%. Document the treated sides and follow applicable claim-line reporting instructions.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery 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
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