$122.35–$142.77
Use 11420 for a smaller excised diameter in the same scalp, neck, hands, feet, or genitalia site group. Include the lesion and necessary margins when measuring.
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CMS RVU26D · Effective 2026-10-01
11421 Lesion excision Medicare reimbursement rates in Virginia
Reports surgical removal of a benign skin lesion on the scalp, neck, hands, feet, or genitalia when the lesion and margins measure 0.6–1 cm. Compare 11421 office and facility rates across CMS payment localities in Virginia.
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 11421 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$155.85–$181.39
2 of 2 localities have a supported rate.
Facility setting
$96.43–$110.17
2 of 2 localities have a supported rate.
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 11421: Benign lesion excision, special sites, 0.6–1 cm
Reports surgical removal of a benign skin lesion on the scalp, neck, hands, feet, or genitalia when the lesion and margins measure 0.6–1 cm.
This code represents full-thickness surgical removal of a benign skin lesion from the scalp, neck, hands, feet, or genitalia. Dermatologists, primary care clinicians, and surgeons commonly perform the procedure in an office or outpatient setting. The reported size is the excised diameter: the lesion’s greatest diameter plus the narrowest margins needed for complete removal. The code is not selected by the length of the incision or the size of the specimen after removal.
Document the lesion’s site, benign diagnosis, excised diameter, and removal method. Routine simple closure is included; a separately performed intermediate or complex repair may be reported when its requirements are met. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 11421
- 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 RVU1.43 · 30%
- Practice expense (office) RVU3.17 · 66%
- Malpractice RVU0.17 · 4%
23.1K
Medicare services in 2024 · #1085 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.
11421 compared with similar codes
Office rates for Virginia, from the same CMS release.
$175.63–$204.43
Use 11422 when the excised diameter falls in the next larger range for the same site group; 11421 is limited to 0.6–1 cm.
$151.57–$177.04
The size range may be similar, but 11401 is for the trunk, arms, or legs. Select the site-specific code before applying the diameter range.
$169.82–$198.02
11441 is for the face or mucous membrane site group, not the scalp, neck, hands, feet, or genitalia group covered by 11421.
Compare 11421 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$181.39
Facility
$110.17
Virginia →
Office / nonfacility
$155.85
Facility
$96.43
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11421 billing questions
How is 11421 distinguished from 11420 or 11422?
Use the excised diameter, including the lesion and the narrowest margins needed for removal. 11421 is for 0.6–1 cm; 11420 is the smaller size range and 11422 the next larger range.
Which body sites qualify for this code?
The site group includes the scalp, neck, hands, feet, and genitalia. A similar-sized lesion on the trunk, arms, or legs belongs to a different site group.
Can the closure be billed separately?
Routine simple closure is included in the excision. A separately performed intermediate or complex repair may be reported when the repair service and documentation support it.
Should modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the services according to the applicable lesion and procedure coding rules rather than using modifier 50.
What documentation supports the size selection?
Record the anatomical site, benign lesion diagnosis, and excised diameter, calculated from the lesion’s greatest diameter plus the narrowest margins. The incision length alone does not establish the code’s size.
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.
1,31311404,,Exc tr-ext b9+marg 3.1-4 cm,A,,2.06,4.50,,2.13,,0.36,6.92,4.55,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,31411406,,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