Summary & Overview

CPT 11643: Excision of Malignant Skin Lesion, Face 2.1–3.0 cm

CPT code 11643 denotes the surgical excision of a malignant skin lesion, including margins, when the lesion measures 2.1 to 3.0 cm in diameter and is located on the face, ears, eyelids, nose, or lips. This code is nationally relevant because skin cancer is common and procedures on cosmetically and functionally sensitive facial sites raise clinical, coding, and payment considerations. Accurate coding affects claims processing, provider reimbursement, and reporting for surgical oncology and dermatologic services.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for excisions on facial sites, expected settings of care, and the role of this code within surgical dermatology. The publication outlines typical reimbursement benchmarks and payer coverage considerations, common modifier use cases, and related coding topics to aid billing clarity. The content also addresses documentation elements tied to lesion size and site that are critical for selecting this code.

The report is structured to help billing staff, practice managers, and policy analysts understand where 11643 fits clinically and administratively, summarize typical payer approaches, and highlight areas where documentation and coding accuracy are most important. Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific rate tables.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare11643CPTskin-excisionsurgical-dermatologyoncologic-surgeryface-surgeryprocedure-coding

Billing Code Overview

CPT code 11643 describes excision of a malignant skin lesion with margins measuring 2.1 to 3.0 cm in diameter. The procedure involves surgical removal of a cancerous (malignant) lesion located on the face, ears, eyelids, nose, or lips, including appropriate margins of surrounding tissue.

Service type: Surgical excision of malignant cutaneous lesion
Typical site of service: Ambulatory surgical center or hospital outpatient setting; minor procedure room in a clinic for appropriate cases

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents to the dermatologic surgery clinic with a biopsy-proven invasive cutaneous squamous cell carcinoma located on the left cheek measuring approximately 2.4 cm in greatest diameter. The patient has controlled hypertension and no anticoagulation. After pre-operative assessment, the surgeon discusses surgical options and obtains informed consent for excision with appropriate margins and anticipated local flap reconstruction. On the day of service the procedure is performed in an outpatient ambulatory surgery center under local anesthesia with monitored anesthesia care; the surgeon excises the malignant lesion including margins, specimens are labeled and sent for pathology, hemostasis achieved, and the defect is repaired with a local advancement flap. The clinical workflow includes pre-op history and physical, lesion mapping and measurements documented, photographic documentation, lesion excision with margin documentation (size 2.4 cm lesion), specimen handling and pathology requisition, surgical repair, post-op instructions, and coding/billing using the appropriate CPT code for excision on the face.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician’s professional interpretation or services separate from technical components (rare for excision procedures).
`50`	Bilateral procedure	When the excision is performed on both sides (left and right) of a paired facial site during the same operative session.
`51`	Multiple procedures	When another unrelated procedure is performed at the same session and payer requires a multiple procedure reduction on secondary codes.
`52`	Reduced services	When the excision is partially reduced or less than described by the CPT code (e.g., smaller margin or aborted procedure).
`53`	Discontinued procedure	When the procedure is started but discontinued due to extenuating circumstances or patient complication prior to completion.
`59`	Distinct procedural service	When two procedures that are normally bundled are performed in distinct anatomic sites or separate sessions and documentation supports distinct services.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct operative components.
`76`	Repeat procedure by same physician	When the same physician repeats the procedure in the global period on the same site.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When a separate unrelated procedure is performed during the global period.
`RT`	Right side	To indicate the procedure was performed on the right side of a lateralized anatomic site.
`LT`	Left side	To indicate the procedure was performed on the left side of a lateralized anatomic site.
`22`	Increased procedural services	When the work or complexity is substantially greater than typically required for the listed procedure (document rationale).
`24`	Unrelated E/M service during postoperative period	When an E/M is reported unrelated to the procedure during the global period (included here though not in original list, see note).

Taxonomy Code	Specialty	Notes
`207P00000X`	Dermatology	Dermatologic surgeons commonly perform skin cancer excisions on face and related repairs.
`208000000X`	General Surgery	General surgeons perform skin and soft tissue cancer excisions, particularly in community or hospital settings.
`2084P0800X`	Plastic Surgery	Plastic and reconstructive surgeons perform excisions with complex closures or flap reconstructions on the face.
`2086S0122X`	Otolaryngology (ENT)	ENT surgeons manage cutaneous malignancies of the ears, nose, and periorbital areas with complex resections and reconstructions.
`208D00000X`	Mohs Micrographic Surgery (Dermatopathology/Mohs)	Mohs surgeons perform tissue-sparing excisions and staged closures; may be involved when margin control is required.

Note: Modifier 24 is commonly used with E/M coding when unrelated evaluation services occur during the postoperative period; it is clinically relevant to the workflow though not listed among the provided modifier codes.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C44.219`	Squamous cell carcinoma of skin of unspecified part of face	Common malignant skin tumor requiring surgical excision on the face.
`C44.312`	Basal cell carcinoma of skin of right eyelid, including canthus	Basal cell carcinoma frequently occurs on the face and is commonly treated with surgical excision.
`C44.319`	Basal cell carcinoma of skin of unspecified eyelid, including canthus	Represents eyelid lesions where precise site may vary; surgical excision is typical.
`C44.422`	Squamous cell carcinoma of skin of left nasal cavity and middle ear	Nasal skin and perinasal lesions on the face often require excision with margins.
`C44.92`	Unspecified malignant neoplasm of skin, unspecified site	Used when a malignant cutaneous lesion is documented but specific site coding is not available.
`D04.9`	Carcinoma in situ of skin, unspecified	In situ lesions on the face may be treated with excision when indicated.
`Z85.820`	Personal history of malignant melanoma of skin	Relevant for surgical planning and surveillance though not the excision indication itself; affects follow-up and coding context.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11642`	Excision, malignant lesion including margins, diameter 1.1 to 2.0 cm, face, ears, eyelids, nose, lips	Used when lesion size falls in the 1.1–2.0 cm range; codes should reflect actual measured lesion diameter.
`11644`	Excision, malignant lesion including margins, diameter 3.1 to 4.0 cm, face, ears, eyelids, nose, lips	Used when lesion diameter exceeds 3.0 cm and falls into the next size bracket; select the code matching the final excised lesion size.
`14060`	Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck; defect 10.1 cm to 30.0 cm	Represents common reconstructive techniques (local flaps) used after wide excision on the face when primary closure is not possible.
`12051`	Repair, intermediate, face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm	Used for layered (intermediate) closure when direct repair is performed after excision and when repair complexity and size meet code descriptors.
`88305`	Level IV pathology; surgical pathology, gross and microscopic examination	Used for histopathologic examination of the excised specimen to confirm margins and diagnosis; billed by pathology services.

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Summary & Overview

CPT 11643: Excision of Malignant Skin Lesion, Face 2.1–3.0 cm

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare11643CPTskin-excisionsurgical-dermatologyoncologic-surgeryface-surgeryprocedure-coding

Billing Code Overview

Service type: Surgical excision of malignant cutaneous lesion
Typical site of service: Ambulatory surgical center or hospital outpatient setting; minor procedure room in a clinic for appropriate cases

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician’s professional interpretation or services separate from technical components (rare for excision procedures).
`50`	Bilateral procedure	When the excision is performed on both sides (left and right) of a paired facial site during the same operative session.
`51`	Multiple procedures	When another unrelated procedure is performed at the same session and payer requires a multiple procedure reduction on secondary codes.
`52`	Reduced services	When the excision is partially reduced or less than described by the CPT code (e.g., smaller margin or aborted procedure).
`53`	Discontinued procedure	When the procedure is started but discontinued due to extenuating circumstances or patient complication prior to completion.
`59`	Distinct procedural service	When two procedures that are normally bundled are performed in distinct anatomic sites or separate sessions and documentation supports distinct services.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct operative components.
`76`	Repeat procedure by same physician	When the same physician repeats the procedure in the global period on the same site.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When a separate unrelated procedure is performed during the global period.
`RT`	Right side	To indicate the procedure was performed on the right side of a lateralized anatomic site.
`LT`	Left side	To indicate the procedure was performed on the left side of a lateralized anatomic site.
`22`	Increased procedural services	When the work or complexity is substantially greater than typically required for the listed procedure (document rationale).
`24`	Unrelated E/M service during postoperative period	When an E/M is reported unrelated to the procedure during the global period (included here though not in original list, see note).

Taxonomy Code	Specialty	Notes
`207P00000X`	Dermatology	Dermatologic surgeons commonly perform skin cancer excisions on face and related repairs.
`208000000X`	General Surgery	General surgeons perform skin and soft tissue cancer excisions, particularly in community or hospital settings.
`2084P0800X`	Plastic Surgery	Plastic and reconstructive surgeons perform excisions with complex closures or flap reconstructions on the face.
`2086S0122X`	Otolaryngology (ENT)	ENT surgeons manage cutaneous malignancies of the ears, nose, and periorbital areas with complex resections and reconstructions.
`208D00000X`	Mohs Micrographic Surgery (Dermatopathology/Mohs)	Mohs surgeons perform tissue-sparing excisions and staged closures; may be involved when margin control is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C44.219`	Squamous cell carcinoma of skin of unspecified part of face	Common malignant skin tumor requiring surgical excision on the face.
`C44.312`	Basal cell carcinoma of skin of right eyelid, including canthus	Basal cell carcinoma frequently occurs on the face and is commonly treated with surgical excision.
`C44.319`	Basal cell carcinoma of skin of unspecified eyelid, including canthus	Represents eyelid lesions where precise site may vary; surgical excision is typical.
`C44.422`	Squamous cell carcinoma of skin of left nasal cavity and middle ear	Nasal skin and perinasal lesions on the face often require excision with margins.
`C44.92`	Unspecified malignant neoplasm of skin, unspecified site	Used when a malignant cutaneous lesion is documented but specific site coding is not available.
`D04.9`	Carcinoma in situ of skin, unspecified	In situ lesions on the face may be treated with excision when indicated.
`Z85.820`	Personal history of malignant melanoma of skin	Relevant for surgical planning and surveillance though not the excision indication itself; affects follow-up and coding context.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11642`	Excision, malignant lesion including margins, diameter 1.1 to 2.0 cm, face, ears, eyelids, nose, lips	Used when lesion size falls in the 1.1–2.0 cm range; codes should reflect actual measured lesion diameter.
`11644`	Excision, malignant lesion including margins, diameter 3.1 to 4.0 cm, face, ears, eyelids, nose, lips	Used when lesion diameter exceeds 3.0 cm and falls into the next size bracket; select the code matching the final excised lesion size.
`14060`	Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck; defect 10.1 cm to 30.0 cm	Represents common reconstructive techniques (local flaps) used after wide excision on the face when primary closure is not possible.
`12051`	Repair, intermediate, face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm	Used for layered (intermediate) closure when direct repair is performed after excision and when repair complexity and size meet code descriptors.
`88305`	Level IV pathology; surgical pathology, gross and microscopic examination	Used for histopathologic examination of the excised specimen to confirm margins and diagnosis; billed by pathology services.