$237.68–$261.15
Both codes cover benign lesion excision in the same anatomic group. Choose 11424 when the total excised diameter is 3.1 to 4 cm; choose 11426 when it exceeds 4 cm.
On this page
CMS RVU26D · Effective 2026-10-01
11426 Benign lesion excision Medicare reimbursement rates in Illinois
Reports excision of a benign skin lesion larger than 4 cm, including margins, from the scalp, neck, hands, feet, or genitalia. Compare 11426 office and facility rates across CMS payment localities in Illinois.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 11426 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$335.93–$369.56
4 of 4 localities have a supported rate.
Facility setting
$249.02–$273.90
4 of 4 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 11426 pays more and less in Illinois
4 payment localities
$335.93 to $369.56
Dermatology procedure
About 11426: Large benign lesion excision of scalp or extremity site
Reports excision of a benign skin lesion larger than 4 cm, including margins, from the scalp, neck, hands, feet, or genitalia.
This code is for surgical removal of a benign skin lesion with a total excised diameter greater than 4 cm, including the lesion and its margins. Typical cases include a large benign nevus or cyst on the scalp, hand, or foot. A physician or other qualified practitioner performs the excision in an office, clinic, or surgical setting; the specimen may be sent for pathology.
Choose the code by the anatomic group and the excised diameter, which includes the lesion plus the narrowest margins—not by lesion size alone. Document the site, lesion dimensions, margins, total excised diameter, and diagnosis; record the closure type and length if a separately reportable repair is performed. Simple closure is included, while intermediate or complex repair may be reported separately when supported. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this descriptor. Assistant-at-surgery payment is barred, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 11426
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.99 · 39%
- Practice expense (office) RVU5.55 · 55%
- Malpractice RVU0.64 · 6%
3.7K
Medicare services in 2024 · #2047 by national volume
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.
11426 compared with similar codes
Office rates for Illinois, from the same CMS release.
$328.51–$363.15
This code is for the scalp, neck, hands, feet, or genitalia. Code 11406 covers the trunk, arms, or legs for a benign lesion larger than 4 cm.
$392.17–$430.08
Use 11446 for a benign lesion larger than 4 cm on the face, ears, eyelids, nose, lips, or mucous membrane; 11426 covers a different anatomic group.
$412.26–$454.32
The anatomic group and size threshold are similar, but 11626 is for malignant lesions. This code is for benign lesions.
Compare 11426 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
4 of 4 payment localities
Chicago →
Office / nonfacility
$369.56
Facility
$273.90
East St. Louis →
Office / nonfacility
$346.87
Facility
$259.29
Rest Of Illinois →
Office / nonfacility
$335.93
Facility
$249.02
Suburban Chicago →
Office / nonfacility
$362.46
Facility
$264.70
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11426 billing questions
How is the greater-than-4-cm threshold measured?
Use the total excised diameter: the lesion plus the narrowest margins. Document the lesion dimensions, margins, and resulting excised diameter.
When should 11424 be used instead?
Use 11424 for the same anatomic group when the total excised diameter is 3.1 to 4 cm. This code is for a diameter greater than 4 cm.
Is wound closure included?
Simple closure is included. An intermediate or complex repair may be separately reported when performed and documented; select the repair code by its site, type, and length.
Can modifier 50 be used for lesions on both sides?
No. Modifier 50 is inappropriate for this descriptor. Report each separately excised lesion according to its site and total excised diameter.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,31711422,,Exc h-f-nk-sp b9+marg 1.1-2,A,,1.64,3.53,,1.87,,0.21,5.38,3.72,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31811423,,Exc h-f-nk-sp b9+marg 2.1-3,A,,2.01,3.97,,2.02,,0.27,6.25,4.30,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31911424,,Exc h-f-nk-sp b9+marg 3.1-4,A,,2.42,4.51,,2.15,,0.37,7.30,4.94,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,32011426,,Exc h-f-nk-sp b9+marg >4 cm,A,,3.99,5.55,,2.70,,0.64,10.18,7.33,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,32111440,,Exc face-mm b9+marg 0.5 cm/<,A,,1.02,3.12,,1.80,,0.11,4.25,2.93,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,32211441,,Exc face-mm b9+marg 0.6-1 cm,A,,1.49,3.52,,1.92,,0.19,5.20,3.60,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,32311442,,Exc face-mm b9+marg 1.1-2 cm,A,,1.73,3.86,,2.00,,0.22,5.81,3.95,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00