Billing code 11643: Malignant lesion excisionMedicare rate & RVUs

Medicare pays $315.97 for 11643 nationally in the office and $193.39 in a hospital or facility. Local office rates run $282.16–$405.69.

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

What 11643 covers

This service removes a malignant skin lesion from the face, ear, eyelid, nose, or lip, including the margins needed for excision. Dermatologists, plastic surgeons, and other physicians who perform skin cancer surgery may provide it in an office or facility. A basal cell or squamous cell carcinoma on the nose or ear is a typical clinical context. The code is selected by the greatest diameter of the lesion plus the margins taken, not by the final closure length. Document the site, malignant diagnosis, and measurement supporting the size range; report each separately excised lesion according to its own site and size.

Simple closure is included; a separately performed intermediate or complex repair may be reported when supported. Medicare includes related postoperative visits during the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 11643 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

11643 rates by state

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

How the 11643 rate is calculated

Each of 11643’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 11643

11643 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

11643 compared with similar codes

How to choose

11642Skin lesion excision

Both codes cover the face, ears, eyelids, nose, or lips; choose 11642 when the lesion plus margins measures 1.1 to 2 cm.

11644Malignant lesion excision

This is the next larger size level for the same anatomic group, used when the lesion plus margins measures 3.1 to 4 cm.

11623Skin excision

The size range is the same, but 11623 applies to a different anatomic group: scalp, neck, hands, feet, or genitalia.

11603Lesion excision

The size range is the same, but 11603 applies to malignant lesions on the trunk or extremities.

Codes related to 11643

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