Billing code 11646: Malignant lesion excisionMedicare rate & RVUs in Texas
Reports surgical removal of a malignant skin lesion on the face or related sites when the excised diameter, including margins, exceeds 4 cm.
Medicare pays $487.93–$528.40 for 11646 in the office in Texas, from Beaumont to Austin. 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 11646 covers
This code covers excision of a malignant skin lesion from the face, ear, eyelid, nose, or lip, with the surrounding margin of tissue. Dermatologists, plastic surgeons, and other qualified surgeons may perform it in an office or outpatient surgical setting. It describes excision rather than Mohs micrographic surgery, which uses a separate technique and code family.
Select the code by anatomical site and the diameter of the excised area, including margins—not the visible lesion alone. Document the lesion dimensions, margins taken, final excised diameter, site, and malignancy. Simple closure is included; a separately documented intermediate or complex repair may be reported when appropriate. CMS assigns a 10-day global period, including related postoperative visits during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery, and does not permit co-surgeons or team surgery for this service.
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 11646 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$487.93 to $528.40
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $528.40 | $335.45 |
| Beaumont | $487.93 | $321.98 |
| Brazoria | $507.51 | $326.78 |
| Dallas | $511.58 | $329.94 |
| Fort Worth | $509.20 | $329.38 |
| Galveston | $509.59 | $328.50 |
| Houston | $526.98 | $345.89 |
| Rest Of Texas | $498.02 | $324.96 |
How the 11646 rate is calculated
Each of 11646’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 · 11646
RVUs × geographic indexes × conversion factor
Work6.10
6.10 RVUs× 1.000 GPCI
Practice expense8.38
8.38 RVUs× 1.000 GPCI
Malpractice0.95
0.95 RVUs× 1.000 GPCI
Adjusted RVUs
15.4300
Conversion factor
$33.4009
Medicare rate
$515.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 11646
11646 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11646
Malignant 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 · 11646
Malignant 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
11646 without 51 · national office
$515.38
Malignant lesion excision
11646-51 · Second procedure: 50%
$257.69
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%).
11646 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 11644Malignant lesion excision
- This code is for the same facial and related sites when the excised diameter exceeds 4 cm; 11644 applies through 4 cm.
- 11606Lesion excision
- Both cover malignant-lesion excision over 4 cm, but 11606 is for the trunk, arms, or legs rather than the face and related sites.
- 11626Skin excision
- Both cover malignant-lesion excision over 4 cm, but 11626 is for the scalp, neck, hands, feet, or genitalia.
- 17311Mohs surgery
- Use 11646 for excision without Mohs staging; 17311 describes the first stage of Mohs surgery with microscopic examination of tissue margins.
11646 billing questions
When should 11646 be selected instead of 11644?
Use 11646 for an excised diameter greater than 4 cm at the face, ear, eyelid, nose, or lip. Code 11644 covers the same sites when the excised diameter is 3.1 to 4 cm.
Is the measurement based on the visible lesion?
No. Select the size level using the excised diameter, including the margins. Document the lesion size, margin taken, and resulting excised diameter.
Can the repair be billed separately?
Simple closure is included. A separately documented intermediate or complex repair may be reported when the repair meets the requirements for that service.
Does modifier 50 apply to lesions on both sides of the face?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Related postoperative visits are included in this code's 10-day global period.
Can an assistant or co-surgeon be billed for this excision?
CMS does not pay an assistant at surgery for this code and does not permit co-surgeons or team surgery.
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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