$155.46
This is the smaller size level for benign lesions in the same anatomic group: 0.6–1.0 cm rather than 1.1–2.0 cm.
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CMS RVU26D · Effective 2026-10-01
11422 Skin lesion excision Medicare reimbursement rates in Vermont
Reports removal of a benign skin lesion from the scalp, neck, hands, feet, or genitalia when its excised diameter, including margins, is 1.1–2.0 cm. Compare 11422 office and facility rates across CMS payment localities in Vermont.
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 11422 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$175.05
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$120.16
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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.
Dermatology procedure
About 11422: Benign lesion excision, scalp or extremity site
Reports removal of a benign skin lesion from the scalp, neck, hands, feet, or genitalia when its excised diameter, including margins, is 1.1–2.0 cm.
A clinician removes a benign skin lesion from the scalp, neck, hand, foot, or genital area, taking the lesion and the required surrounding margin. Dermatologists, surgeons, and other qualified clinicians commonly perform this procedure in an office or outpatient setting for lesions such as benign nevi or cysts. The code is selected by the excised diameter, measured across the lesion and its margins, not by the length of the final incision or closure. Simple closure is included; a separately reportable intermediate or complex repair may be coded when performed and documented.
Report this level when the measured excision is 1.1–2.0 cm. Document the lesion’s site, benign indication, dimensions with margins, and the procedure performed. The 10-day global period includes related postoperative visits during that period. When multiple procedures occur in one session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 11422
- 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 RVU1.64 · 30%
- Practice expense (office) RVU3.53 · 66%
- Malpractice RVU0.21 · 4%
34.4K
Medicare services in 2024 · #925 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.
11422 compared with similar codes
Office rates for Vermont, from the same CMS release.
$202.97
This is the larger size level for benign lesions in the same anatomic group: 2.1–3.0 cm rather than 1.1–2.0 cm.
$166.86
The size range is the same, but 11402 is for lesions on the trunk, arms, or legs rather than the scalp, neck, hands, feet, or genitalia.
$243.92
Use 11622 for a malignant lesion in the same anatomic group and size range; this code is for benign lesions.
Compare 11422 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
$175.05
Facility
$120.16
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 11422 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,317
- Code
- 11422
- Physician work
- 1.64
- Practice expense
- 3.53
- Malpractice
- 0.21
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.64 | × 1.000 | 1.6400 |
| Practice expense | 3.53 | × 0.990 | 3.4947 |
| Malpractice | 0.21 | × 0.506 | 0.1063 |
| Total RVUs | 5.2410 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$175.05
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 3.53 | 0.99 |
| Malpractice | 0.21 | 0.506 |
(1.64 × 1 + 3.53 × 0.99 + 0.21 × 0.506) × $33.4009 = $175.05
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 1.87 | 0.99 |
| Malpractice | 0.21 | 0.506 |
(1.64 × 1 + 1.87 × 0.99 + 0.21 × 0.506) × $33.4009 = $120.16
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
11422 billing questions
How is the 1.1–2.0 cm size determined?
Measure the excised diameter across the lesion and its margins. Do not use the incision or repair length as the excised diameter.
When should 11421 or 11423 be reported instead?
Use 11421 for the same anatomic group when the excised diameter is 0.6–1.0 cm, and 11423 when it is 2.1–3.0 cm.
Can the repair be billed separately?
Simple closure is included in the excision. A separately reportable intermediate or complex repair may be coded when the documented closure meets that repair service’s requirements.
Can modifier 50 be used for lesions on both sides?
No. Modifier 50 is inappropriate for this code; the CMS bilateral adjustment does not apply to its descriptor or anatomy.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures subject to the multiple-procedure rule are paid at 50%.
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.
1,31411406,,Exc tr-ext b9+marg >4.0 cm,A,,3.43,5.92,,2.75,,0.64,9.99,6.82,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31511420,,Exc h-f-nk-sp b9+marg 0.5/<,A,,1.00,2.63,,1.17,,0.11,3.74,2.28,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31611421,,Exc h-f-nk-sp b9+marg 0.6-1,A,,1.43,3.17,,1.36,,0.17,4.77,2.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31711422,,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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817