Billing code 11640: Lesion excisionMedicare rate & RVUs in Maine
Reports excision of a malignant skin lesion on the face or specified facial sites when the lesion and required margins measure 0.5 cm or less.
Medicare pays $188.58–$198.67 for 11640 in the office in Maine, from Rest Of Maine to Southern Maine. Which amount applies depends on the service address.
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 9 sections
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 in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | $188.58 | $104.38 |
| Southern Maine | $198.67 | $107.98 |
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.
How the rate is built · 11640
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.63Practice expense 4.23Malpractice 0.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11640
11640 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11640
Lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 11640
Lesion excision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11640 without 51 · national office
$202.41
Lesion excision
11640-51 · Second procedure: 50%
$101.21
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
11640 compared with similar codes
Compare codes
11640 vs 11641 vs 11600 vs 11620: national Medicare rates
Swap in your local Medicare rate.
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.
11640 billing questions
How is the size category determined?
Use the excised diameter, including the lesion and the margins taken, rather than the lesion’s diameter alone. This code is for an excised diameter of 0.5 cm or less.
Which sites qualify for this code?
The site must be the face, ear, eyelid, nose, or lip. For the same size category on a different anatomic group, use the code assigned to that group.
Is simple closure separately reported?
Simple closure is included in the excision service. A separately performed intermediate or complex repair may be reported when its documentation supports that repair.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
What happens when multiple procedures are performed in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple procedure reduction to the other procedures.
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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