Billing code 11604: Malignant excisionMedicare rate & RVUs

Medicare pays $310.96 for 11604 nationally in the office and $181.03 in a hospital or facility. Local office rates run $277.07–$402.04.

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

What 11604 covers

A dermatologist, surgeon, or other qualified practitioner uses this code to remove a malignant skin lesion from the trunk or an arm or leg. The coded size is the greatest diameter of the lesion plus the margins taken for excision—not the length of the resulting wound or closure. The excised tissue is typically submitted for pathologic examination. Simple closure is included in the excision; a separately documented intermediate or complex repair may be reported when performed.

Select the size level using the documented lesion diameter and margins, measured before removal. Record the lesion’s site, clinical size, margins, and excision performed so the reported diameter is supported. CMS assigns a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; 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 11604 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

11604 rates by state

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

How the 11604 rate is calculated

Each of 11604’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.

Payment rules and modifiers for 11604

11604 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

11604 compared with similar codes

How to choose

11603Lesion excision

Use 11603 when the lesion plus margins measures 2.1–3 cm; use 11604 when that diameter measures 3.1–4 cm.

11606Lesion excision

Use 11606 for a trunk or extremity excision diameter greater than 4 cm. A diameter from 3.1 through 4 cm falls under 11604.

11624Skin excision

The size range is the same, but 11624 is for the scalp, neck, hands, feet, or genitalia rather than the trunk or extremities.

11404Skin excision

11404 is for excision of a benign lesion on the trunk or extremity in the same size range. Code 11604 is for a malignant lesion.

Codes related to 11604

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

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

Open CMS sourceHow we calculate rates