$269.05
Use 11603 when the lesion plus margins measures 2.1–3 cm; use 11604 when that diameter measures 3.1–4 cm.
On this page
CMS RVU26D · Effective 2026-10-01
11604 Malignant excision Medicare reimbursement rates in Vermont
Reports excision of a malignant skin lesion on the trunk or extremity when the lesion and required margins measure 3.1–4 cm across. Compare 11604 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 11604 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
$302.42
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$173.79
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 11604: Malignant lesion excision, trunk or extremity, 3.1–4 cm
Reports excision of a malignant skin lesion on the trunk or extremity when the lesion and required margins measure 3.1–4 cm across.
A dermatologist, surgeon, or other qualified practitioner uses this code to remove a malignant skin lesion from the trunk or an arm or leg. The coded size is the greatest diameter of the lesion plus the margins taken for excision—not the length of the resulting wound or closure. The excised tissue is typically submitted for pathologic examination. Simple closure is included in the excision; a separately documented intermediate or complex repair may be reported when performed.
Select the size level using the documented lesion diameter and margins, measured before removal. Record the lesion’s site, clinical size, margins, and excision performed so the reported diameter is supported. CMS assigns a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 11604
- 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 RVU3.09 · 33%
- Practice expense (office) RVU5.82 · 63%
- Malpractice RVU0.40 · 4%
38.3K
Medicare services in 2024 · #889 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.
11604 compared with similar codes
Office rates for Vermont, from the same CMS release.
$447.02
Use 11606 for a trunk or extremity excision diameter greater than 4 cm. A diameter from 3.1 through 4 cm falls under 11604.
$329.38
The size range is the same, but 11624 is for the scalp, neck, hands, feet, or genitalia rather than the trunk or extremities.
$223.69
11404 is for excision of a benign lesion on the trunk or extremity in the same size range. Code 11604 is for a malignant lesion.
Compare 11604 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
$302.42
Facility
$173.79
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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 11604 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,344
- Code
- 11604
- Physician work
- 3.09
- Practice expense
- 5.82
- Malpractice
- 0.40
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.09 | × 1.000 | 3.0900 |
| Practice expense | 5.82 | × 0.990 | 5.7618 |
| Malpractice | 0.40 | × 0.506 | 0.2024 |
| Total RVUs | 9.0542 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$302.42
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.09 | 1 |
| Practice expense | 5.82 | 0.99 |
| Malpractice | 0.4 | 0.506 |
(3.09 × 1 + 5.82 × 0.99 + 0.4 × 0.506) × $33.4009 = $302.42
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.09 | 1 |
| Practice expense | 1.93 | 0.99 |
| Malpractice | 0.4 | 0.506 |
(3.09 × 1 + 1.93 × 0.99 + 0.4 × 0.506) × $33.4009 = $173.79
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.
11604 billing questions
How is the 3.1–4 cm size determined?
Use the greatest diameter of the lesion together with the margins taken for excision. The wound or closure length does not determine the size level.
Can the repair be billed separately?
Simple closure is included in the excision. A separately documented intermediate or complex repair may be reported when performed.
Does the 10-day global include postoperative visits?
Yes. Related postoperative visits during the 10-day global period are included.
Can modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code. When multiple procedures are performed in the same session, the standard multiple-procedure reduction applies.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted for this code.
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.
1,34111601,,Exc tr-ext mal+marg 0.6-1 cm,A,,2.02,4.54,,1.58,,0.24,6.80,3.84,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,34211602,,Exc tr-ext mal+marg 1.1-2 cm,A,,2.21,4.76,,1.65,,0.23,7.20,4.09,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,34311603,,Exc tr-ext mal+marg 2.1-3 cm,A,,2.75,5.19,,1.81,,0.33,8.27,4.89,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,34411604,,Exc tr-ext mal+marg 3.1-4 cm,A,,3.09,5.82,,1.93,,0.40,9.31,5.42,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,34511606,,Exc tr-ext mal+marg >4 cm,A,,4.89,8.15,,2.51,,0.84,13.88,8.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,3461160F,,Rvw meds by rx/dr in rcrd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,34711620,,Exc h-f-nk-sp mal+marg 0.5/<,A,,1.60,4.14,,1.46,,0.21,5.95,3.27,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,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