Summary & Overview

CPT 11646: Excision of Malignant Skin Lesion on Face >4.0 cm

CPT code 11646 designates the surgical excision of a malignant skin lesion larger than 4.0 cm located on high-visibility facial sites — including the face, ears, eyelids, nose, and lips. This code captures a higher-complexity dermatologic oncology procedure where achieving clear margins and preserving form and function are primary clinical goals. Nationally, coding and billing for large facial skin cancer excisions affect surgical practices, hospital outpatient departments, and payer reimbursement patterns for complex dermatologic surgery.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context for use of the code, typical sites of service, and common modifiers associated with surgical procedures. The publication summarizes benchmarking considerations and policy factors that influence coverage and payment for major excisions of malignant lesions on cosmetically and functionally important facial areas. It also outlines what to expect in documentation requirements and coding elements relevant to the procedure. Data not available in the input includes specific ICD-10 diagnoses, payer-specific fee schedules, and associated taxonomy details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 11646Dermatologic surgerySkin cancer excisionOutpatient surgerySurgical oncologyProcedure codingFacial reconstructionMargin excision

Billing Code Overview

CPT code 11646 describes the excision of a malignant skin lesion, including margins, greater than 4.0 cm in diameter, performed on the face, ears, eyelids, nose, or lips. This procedure involves surgical removal of a cancerous skin tumor with appropriate margins to ensure complete excision.

Service type: Surgical excision of a malignant skin lesion
Typical site of service: Outpatient surgical center or hospital operating room for procedures on the face, ears, eyelids, nose, or lips

Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to a dermatologic or surgical clinic with a biopsy-confirmed malignant cutaneous tumor (for example, squamous cell carcinoma or basal cell carcinoma) located on the nose measuring greater than 4.0 cm in maximum diameter. The provider evaluates the lesion, reviews the pathology, obtains informed consent, and schedules an excision in an ambulatory surgical center or hospital outpatient department. On the day of service the patient undergoes local anesthesia with sedation or general anesthesia as clinically indicated; the surgeon excises the lesion with appropriate margins and performs necessary reconstruction (primary closure, flap, or graft) to restore form and function of the face. Specimens are labeled and sent to pathology for permanent section analysis. Postoperative instructions and wound care are provided, and follow-up visits are arranged for wound check and pathology review. Typical site of service: outpatient surgical center or hospital outpatient department. Service type: surgical excision of malignant skin lesion with margins on cosmetically and functionally sensitive facial areas.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use if identical malignant lesions on symmetric facial sites are excised in the same operative session and payer allows bilateral reporting.

51

Taxonomy Code	Specialty	Notes
207P00000X	Dermatology	Dermatologic surgeons commonly perform facial skin cancer excisions and reconstructions.
208C00000X	Plastic Surgery	Plastic surgeons perform complex facial reconstructions after large excisions.
207L00000X	Dermatopathology	Dermatopathologists interpret excision specimens (pathology reporting).
207K00000X	General Surgery	General surgeons may perform excision when specialized reconstructive care is not required.
208000000X	Otolaryngology (ENT)	Otolaryngologists perform excisions and reconstructions on lesions involving nasal or periorbital areas.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C44.311`	Basal cell carcinoma of skin of right eyelid, including canthus	Common malignant skin cancer on facial sites requiring excision with margins.
`C44.312`	Basal cell carcinoma of skin of left eyelid, including canthus	Same as above for left-sided lesions.
`C44.319`	Basal cell carcinoma of skin of eyelid, unspecified	Used when laterality not specified in documentation.
`C44.21`	Squamous cell carcinoma of skin of ear and external auricular canal	Squamous cell carcinomas on ear/face often require wider excision.
`C44.31`	Basal cell carcinoma of skin of eyelid and periocular area	Reflects malignant lesions in cosmetically sensitive facial sites requiring specialized excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11646`	Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm	This is the primary procedure for large malignant cutaneous lesions on the face.
`14040`	Adjacent tissue transfer or rearrangement, trunk; simple	Used when local flap reconstruction of the surgical defect is required after excision (select technique based on anatomic site).
`15271`	Full-thickness graft, nose; complex, including cartilage graft when performed	Used when full-thickness skin grafting is performed to reconstruct a facial defect post-excision.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used for permanent pathology evaluation of excised malignant specimens to determine margins and tumor characteristics.
`99024`	Postoperative follow-up visit global period - routine postoperative care	Used for routine postoperative visit within the global period for wound check and follow-up.