Billing code 11642: Skin lesion excisionMedicare rate & RVUs in Nebraska
Report this code for excision of a malignant skin lesion on the face, ear, eyelid, nose, or lip when the excised diameter is 1.1–2 cm.
Medicare pays $247.42 for 11642 in the office in Nebraska (Nebraska). 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 11642 covers
This code covers conventional excision of a malignant skin lesion on the face, ears, eyelids, nose, or lips. Dermatologists, plastic surgeons, and other qualified clinicians commonly perform the procedure in an office or outpatient setting. The excision removes the lesion with the margins needed for the planned treatment; it is distinct from Mohs surgery. Simple closure is included, while a separately reportable intermediate or complex repair may be coded when its requirements are met.
Choose the code by the anatomic site group and the excised diameter: the lesion’s greatest diameter plus the narrowest margins removed. Document the diagnosis, exact site, lesion and margin measurements, and closure performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. CMS does not pay an assistant at surgery for this service and does not permit co-surgeon or team-surgery billing.
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.
11642 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $247.42 | $143.84 |
How the 11642 rate is calculated
Each of 11642’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 · 11642
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.55Practice expense 5.14Malpractice 0.30
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11642
11642 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11642
Skin 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 · 11642
Skin 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
11642 without 51 · national office
$266.87
Skin lesion excision
11642-51 · Second procedure: 50%
$133.44
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%).
11642 compared with similar codes
Compare codes
11642 vs 11641 vs 11643 vs 11602 vs 11622: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11641Malignant lesion excision
- Both cover malignant lesions in the same site group; 11641 applies when the excised diameter is 0.6–1 cm rather than 1.1–2 cm.
- 11643Malignant lesion excision
- This code is for an excised diameter of 1.1–2 cm; 11643 is for 2.1–3 cm at the same sites.
- 11602Malignant lesion excision
- The size range is the same, but 11602 applies to the trunk, arms, or legs rather than the face, ears, eyelids, nose, or lips.
- 11622Skin lesion excision
- The size range is the same, but 11622 applies to the scalp, neck, hands, feet, or genitalia.
11642 billing questions
How is the 1.1–2 cm size determined?
Use the excised diameter: the lesion’s greatest diameter plus the narrowest margins removed. Document the measurements that support the selected size range.
Does the code include closing the wound?
Simple closure is included. An intermediate or complex repair may be separately reported when supported by the repair documentation and applicable coding requirements.
When should 11641 be used instead?
Use 11641 for the same anatomic site group when the excised diameter is 0.6–1 cm. The size is based on the lesion and margins, not the length of the closure.
Does the 10-day global period include wound checks?
Related postoperative visits during the 10-day global period are included in this procedure.
What happens if another procedure is performed in the same session?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay an assistant at surgery for this service and does not permit co-surgeon or team-surgery billing.
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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