Billing code 11426: Benign lesion excisionMedicare rate & RVUs in Oregon
Reports excision of a benign skin lesion larger than 4 cm, including margins, from the scalp, neck, hands, feet, or genitalia.
Medicare pays $332.93–$357.26 for 11426 in the office in Oregon, from Rest Of Oregon to Portland. 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 11426 covers
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.
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 11426 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $357.26 | $251.50 |
| Rest Of Oregon | $332.93 | $238.12 |
How the 11426 rate is calculated
Each of 11426’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 · 11426
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.99Practice expense 5.55Malpractice 0.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11426
11426 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11426
Benign 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 · 11426
Benign 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
11426 without 51 · national office
$340.02
Benign lesion excision
11426-51 · Second procedure: 50%
$170.01
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%).
11426 compared with similar codes
Compare codes
11426 vs 11424 vs 11406 vs 11446 vs 11626: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11424Lesion excision
- 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.
- 11406Skin lesion excision
- 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.
- 11446Skin lesion excision
- 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.
- 11626Skin excision
- The anatomic group and size threshold are similar, but 11626 is for malignant lesions. This code is for benign lesions.
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 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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