Billing code 11640: Lesion excisionMedicare rate & RVUs

Medicare pays $202.41 for 11640 nationally in the office and $110.89 in a hospital or facility. Local office rates run $179.25–$267.75.

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

What 11640 covers

This code covers removal of a malignant skin lesion from the face, ear, eyelid, nose, or lip, with the margins needed for excision. Dermatologists, plastic surgeons, and other qualified physicians commonly perform the procedure in an office or outpatient surgical setting. The size category is based on the excised diameter, including the lesion and margins—not the lesion alone. The code includes simple closure; a separately performed intermediate or complex repair may be reported when supported by the service and documentation.

Choose this code when the anatomic site is one of the specified facial sites and the excised diameter is 0.5 cm or less. Document the lesion’s location and size, the margins taken, and the resulting excised diameter; retain pathology findings supporting the malignant diagnosis. CMS assigns a 10-day global period, so related postoperative visits during that period are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment is statutorily restricted, and 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 11640 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

11640 rates by state

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

How the 11640 rate is calculated

Each of 11640’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 11640

11640 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

11640 compared with similar codes

How to choose

11641Malignant lesion excision

Use 11641 for the same facial sites when the excised diameter is 0.6–1 cm; 11640 is limited to 0.5 cm or less.

11600Malignant lesion excision

This code is for the specified facial sites. Code 11600 is the corresponding small-lesion category for specified trunk and extremity sites.

11620Skin excision

This code covers specified facial sites; 11620 is the small-lesion category for specified scalp, neck, hand, foot, and genital sites.

Codes related to 11640

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