CPT code 11624: Excision of malignant lesion, 3.1-4.0 cm

Key takeaways

CPT code 11624 covers excision of a malignant lesion measuring 3.1 to 4.0 cm on the scalp, neck, hands, feet, or genitalia. That figure is the excised diameter, margins included.

The tier below is 11623 at 2.1 to 3.0 cm. The tier above is 11626 at over 4.0 cm, because CPT 11625 does not exist.

Code from the measurement taken before the excision, which is the lesion plus its narrowest margin. Tissue shrinks in formalin, so the pathology report reads low.

Simple closure is bundled into 11624 and cannot be billed separately. Only intermediate or complex repair codes may be reported in addition.

Practice management software like Pabau can require the excised diameter and the pathology report in the note. Claims then leave with the documentation Medicare expects.

CPT code 11624 covers the excision of a malignant skin lesion from the scalp, neck, hands, feet, or genitalia. It applies when the excised diameter measures 3.1 to 4.0 cm, margins included.

That one measurement is where the money leaks. Coders often work from the lesion alone, or from the specimen size printed on the pathology report. Both numbers read low, so the claim pays as 11623.

Site, size, and pathology then settle almost everything else, from the ICD-10 pairing to the fee schedule line.

CPT code 11624 covers five sites and one size band

CPT code 11624 is maintained by the American Medical Association (AMA). It covers excision of a malignant skin lesion on the scalp, neck, hands, feet, or genitalia.

The code applies when the excised diameter, including the narrowest surgical margin, measures 3.1 to 4.0 cm. It belongs to the 11620-11626 series in the Surgery chapter’s Excision-Malignant Lesions section.

The AMA descriptor reads: Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm.

Two variables drive code selection, the anatomical site and the excised diameter. Both have to match the operative record. Work from the measurement the surgeon takes before cutting, never from the specimen size on the pathology report.

Tissue shrinks by roughly 10 to 30 percent once the tension releases and the formalin does its work. The specimen therefore reads smaller than what the surgeon removed.

Practice management software like Pabau keeps both values on the procedure record. Teams running dermatology EMR workflows can capture that diameter at the time of surgery. They then attach the pathology report before the claim goes out.

Every 11624 coding parameter in one table

The table below collects the parameters that decide an 11624 claim.

The excised diameter includes the narrowest margin taken around the lesion, not the widest. A 3.0 cm lesion removed with a 0.3 cm margin on its shortest axis measures 3.6 cm. That figure sits inside the 11624 band.

How the 11600-11646 series splits into three site groups

The malignant excision codes split into three anatomical groups. Every group repeats the same size tiers, so picking the wrong group is a common miscoding error.

• 11600-11606: trunk, arms, and legs.
• 11620-11626: scalp, neck, hands, feet, and genitalia. CPT code 11624 sits here.
• 11640-11646: face, ears, eyelids, nose, and lips.

Each group also skips a number. After the 3.1 to 4.0 cm code, the series jumps straight to the over 4.0 cm code. That is why 11605, 11625, and 11645 do not exist. Reimbursement then differs by group, even at an identical diameter.

Site group picks the family, size picks the code

Site group comes first, diameter second. A 3.6 cm excised diameter on the forearm codes to 11604, in the trunk, arms, and legs group. The same 3.6 cm on the back of the hand codes to 11624. Move it to the eyelid and it becomes 11644.

Within a group, only the measurement moves the code. Take that hand excision down to 2.8 cm and it becomes 11623. Drop it to 1.8 cm and 11622 applies. Push it past 4.0 cm and it becomes 11626.

CPT code 11621 covers the 0.6 to 1.0 cm band on the same five sites. For the trunk, arms, and legs above 4.0 cm, use CPT code 11606.

Shave removal and destruction are not excisions

Excision means full-thickness removal through the dermis, with margins. Two other techniques read almost the same in a chart note and code somewhere else entirely.

A shave on the back of the hand codes to 11312, even when pathology comes back malignant. Premalignant lesions treated with cryosurgery code to 17000 and its add-on instead.

A benign result moves the claim to the 11420 series

The 11600 series needs a pathology report confirming malignancy. If the specimen returns benign, the excision codes to the benign series instead. For these five sites that series runs 11420-11426, and 11424 carries the 3.1 to 4.0 cm band.

So take the diagnosis from the pathology report, and take the measurement from the operative note. Billing a malignant code on a benign result invites a refund request. CPT code 11423 walks through the benign series and the documentation it needs.

Pair 11624 with an ICD-10 code that matches the site

Medicare coverage for CPT code 11624 requires a supporting ICD-10-CM diagnosis that establishes medical necessity. The diagnosis has to match the site and the histology in the pathology report.

The C44.6 and C44.7 subcategories need a sixth character for laterality. C44.61 or C44.71 on their own will reject as non-specific.

Genital skin lesions leave the C44 range altogether. Vulvar, penile, and scrotal malignancies code to C51, C60, and C63 instead.

Always code to the highest specificity available. If the pathology report names a specific histology and site, use the matching specific code. A non-specific code where a specific one exists reads as a documentation weakness and can prompt payer review.

The modifiers 11624 needs, and the one it never takes

Modifier choice moves both payment and audit risk. A wrong modifier, or a missing one, can trigger a rejection or a payer review. The table below covers what comes up on 11624 claims.

Always verify modifier requirements with your specific payer. Medicare’s bundling and modifier edits sit in the National Correct Coding Initiative, and commercial insurers often apply rules of their own.

Six things the 11624 note has to say

Medicare’s coverage rules for this procedure sit in a Local Coverage Determination. First Coast Service Options publishes LCD L33818, with a companion article A57660. Other contractors publish their own version, so check the policy in your jurisdiction.

The clinical record has to carry each element below. Missing one is grounds for denial or post-payment recoupment.

1. Lesion location: Identify the specific anatomical site (scalp, neck, hand, foot, or genitalia) in the operative note and the pathology request.
2. Excised diameter including margins: Record the lesion plus its narrowest margin, measured before the excision. This is the number that selects the code, not the lesion alone and not the specimen size after fixation.
3. Clinical indication: Document the presentation that supported the decision to excise, such as suspicious pigmentation, lesion growth, irregular borders, or skin cancer risk factors.
4. Histopathologic confirmation: A pathology report confirming malignancy must be present in the record. Medicare will not cover CPT 11624 without it.
5. Repair method: Note whether closure was simple, which is bundled, or required intermediate or complex repair, which is separately reportable. If a repair code is billed, document why the repair exceeded simple closure.
6. Surgeon attestation: The operating physician must sign and date the operative note. Undated or unsigned notes fail documentation standards.

Practices using digital clinical forms can build a standing excision template that asks for each field at the point of care. Nothing then reaches the coder half-finished.

When Medicare covers an 11624 excision, and when it won’t

Under LCD L33818, excision of a malignant skin lesion is covered when it is medically necessary. Medicare looks for three things. The presentation has to be consistent with malignancy, and the operative approach has to suit the lesion’s size and site. Pathology then has to confirm the malignancy.

Four limitations matter in day-to-day practice.

• Claims submitted before pathology results arrive may be denied if the final diagnosis does not confirm malignancy. Some practices hold the claim until pathology is returned.
• Prophylactic excision of a benign lesion does not meet medical necessity criteria for the malignant excision series.
• If an initial excision was incomplete and re-excision is required, document the original pathology result and the clinical rationale in the new operative note.
• Prior authorization is not typically required for CPT 11624 under Medicare fee-for-service, but Medicare Advantage plans vary. Verify with individual plans before scheduling.

What 11624 pays in 2026, office versus facility

Medicare pays two different rates for CPT code 11624, depending on where the procedure happens. The office rate is higher because the practice carries the overhead. Confirm the figure for your own locality in the CMS Physician Fee Schedule.

Both figures come from the 2026 national fee schedule at a conversion factor of $33.4009. Clinicians who qualify as advanced APM participants bill against a slightly higher factor of $33.5675. High-cost localities pay above these numbers, and rural localities often pay below.

The RVUs behind the 11624 payment

Relative value units, or RVUs, set the payment before geographic adjustment. The 2026 national values are below.

Payment equals total RVU multiplied by the conversion factor, once each component is adjusted by its geographic practice cost index. At $33.4009, that lands near $339 in the office and near $203 in a facility.

Walk a 3.6 cm scalp excision through the claim

A patient presents with a crusted lesion on the scalp that has been growing for months. The lesion measures 3.0 cm. A 0.3 cm margin on each side takes the excised diameter to 3.6 cm.

The operative note records the site as scalp, the excised diameter as 3.6 cm, and a single-layer closure. Pathology returns basal cell carcinoma, and the specimen measures 3.2 cm after fixation.

That 3.2 cm figure never touches the claim. The line goes out as 11624 paired with C44.41, on the strength of the 3.6 cm the surgeon measured before cutting.

Simple closure stays bundled, so no repair code is added. At the 2026 office rate, the line is worth roughly $339 before geographic adjustment.

Run this check before you submit

Seven mistakes that get 11624 denied

Denials for CPT code 11624 cluster around a handful of predictable mistakes. Catching them at documentation, rather than at appeal, saves the billing team a lot of rework.

Measurement mistakes that down-code the claim

• Measuring the lesion without its margins: The most common error. The 3.1 to 4.0 cm threshold covers the lesion plus the narrowest margin taken around it. A note that records the lesion alone reads one tier low.
• Coding from the specimen size on the pathology report: Fixation shrinks the tissue, so a 3.6 cm excision can arrive back at 3.2 cm. Use the surgeon’s pre-excision measurement instead.
• Site group miscoding: Using 11604 for a lesion that sits on the neck or scalp, or the reverse. Both groups carry a 3.1 to 4.0 cm code, and the rates differ.

Bundling and modifier mistakes that trigger denials

• Billing a code that does not exist: Coders sometimes reach for 11625, because the trunk group has 11604 in the 3.1 to 4.0 cm slot. This group runs 11624 then 11626, so 11625 rejects as invalid.
• Unbundling simple closure: Adding a repair code from the 12001-12007 range when only simple closure was performed. Intermediate repairs from 12031-12057, and complex repairs such as 13120, are the only closures billed on top.
• Billing a same-session biopsy separately: A biopsy of the same lesion in the same session is bundled into the excision. A biopsy taken at an earlier visit, such as 11102, is billed on its own date.
• Applying modifier 22 without documentation: Modifier 22 raises payment, but it needs a note explaining why the work was substantially harder than usual. Claims carrying it without support draw audits.

How Pabau keeps excision measurements and claims together

Most excision notes are free text, so the excised diameter depends on whoever typed it. Coders then bill from a number that may never have included the margins.

Pabau turns those values into fields. A procedure template in our skin clinic software can require the site, the pre-excision diameter, and the pathology referral before the note is signed. Photos and reports stay on the same patient record.

Pabau’s claims management software then checks the fields an insurer needs and shows where each submission stands. Fewer 11624 claims come back down-coded, and the notes still read clearly when an auditor opens them years later.

Streamline your dermatology billing with Pabau

Pabau's claims management tools help dermatology and surgical practices capture excised diameters, attach pathology reports, and submit claims from the same patient record. See how it works in your practice.

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Conclusion

Coding CPT code 11624 comes down to two values in the operative note. One is the site group, which is the scalp, neck, hands, feet, or genitalia. The other is the excised diameter at 3.1 to 4.0 cm, margins included and measured before the excision.

Get either wrong and the claim lands in the wrong fee schedule or a denial queue. Remember too that the series skips 11625. Anything over 4.0 cm on these five sites is 11626, not the next number up.

Practices that capture the diameter once, in a field the note will not let them skip, stop arguing about tiers months later. Pabau does that, then checks the fields an insurer needs and shows where each submission stands. Book a demo to see how it handles malignant excision notes and claims.

Continue your research

Coding the same excision on the face? CPT code 11643 covers the 2.1 to 3.0 cm band on the face, ears, eyelids, nose, and lips.

Closing the defect with a complex repair? CPT code 13131 covers complex repair of the hands, feet, and genitalia from 1.1 to 2.5 cm.

Layered closure rather than complex? CPT code 12034 covers intermediate repair of the scalp, trunk, and extremities from 7.6 to 12.5 cm.

Billing the punch biopsy that came first? CPT code 11104 covers a punch biopsy of a single lesion, including simple closure.

Need the smallest tier in the facial group? CPT code 11640 covers a malignant excision of 0.5 cm or less on the face, ears, and lips.

Frequently asked questions