How much does Medicare pay for CPT 11642?

Medicare allowed an average of $146.34 per service and paid $114.08 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $590.24, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11642?

Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm. It was billed 34,432 times to 30,034 Medicare beneficiaries by 1,007 providers in 2024.

Does 11642 pay differently in an office than a hospital?

Yes. The allowed amount averaged $151.42 in an office setting and $98.40 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 11642 most?

Dermatology, with 25,210 services from 681 clinicians. Next are Plastic and Reconstructive Surgery, Physician Assistant, Ambulatory Surgical Center.

CPT 11642

Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm

$146.34Medicare-allowed amount per service, averaged across 34,432 services

Providers submitted

$590.24

Asking price, not received

Medicare allowed

$146.34

The fee schedule figure

Medicare paid

$114.08

Balance is patient coinsurance

Providers submitted an average of $590.24 for this code and Medicare allowed $146.34 — 4.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $114.08 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $151.42
Hospital / facility: $98.40

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 31,132 services were billed in an office setting and 3,300 in a facility.

Services: 34,432
Beneficiaries: 30,034
Providers billing it: 1,007
Total allowed: $5,038,779

What Medicare pays for CPT 11642

Across 34,432 services billed by 1,007 providers to 30,034 beneficiaries, Medicare allowed an average of $146.34 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 11642

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	25,210	21,932	$151.55	681
Plastic and Reconstructive Surgery	4,433	3,851	$133.72	150
Physician Assistant	1,162	1,048	$129.76	45
Ambulatory Surgical Center	1,148	1,018	$87.85	34
Otolaryngology	1,061	950	$140.09	46
General Surgery	371	302	$172.30	9
Nurse Practitioner	321	288	$159.55	13
Micrographic Dermatologic Surgery	256	241	$164.12	10
Family Practice	214	163	$170.63	7
Ophthalmology	101	95	$143.06	5
Emergency Medicine	44	41	$120.46	2
Undefined Physician type	42	41	$91.64	1
Internal Medicine	28	25	$121.11	1
Interventional Pain Management	17	17	$129.62	1
Hand Surgery	13	11	$85.16	1

11642 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	5,552	$149.33	$115.21	138
California	3,733	$185.47	$127.15	76
Texas	2,756	$148.41	$117.87	87
Georgia	1,580	$134.64	$112.14	38
Pennsylvania	1,401	$141.94	$110.79	44
South Carolina	1,298	$132.08	$108.35	33
North Carolina	1,098	$133.50	$110.46	30
Mississippi	1,092	$127.72	$109.07	26
Virginia	1,035	$143.72	$111.31	34
Illinois	1,011	$153.17	$116.42	31
Indiana	970	$130.58	$109.26	17
Arizona	906	$154.99	$121.46	30
Ohio	836	$134.77	$109.13	36
Alabama	813	$140.71	$120.96	24
Nebraska	708	$140.27	$116.30	17
New York	699	$153.21	$115.57	21
Maryland	690	$161.57	$118.59	24
Louisiana	663	$129.07	$107.81	18
Tennessee	646	$126.73	$109.52	18
Massachusetts	615	$141.19	$103.39	22
Missouri	536	$120.31	$102.59	22
Oregon	497	$146.93	$115.05	15
Iowa	449	$120.70	$101.77	14
Kentucky	439	$121.33	$106.29	14
Oklahoma	361	$121.66	$101.49	14
Wyoming	343	$124.02	$98.13	6
Michigan	322	$138.89	$109.26	14
Wisconsin	318	$146.57	$117.91	12
Washington	296	$147.73	$107.87	14
Kansas	287	$122.58	$103.79	10
Utah	255	$139.12	$112.38	10
Colorado	218	$138.53	$105.71	9
Idaho	215	$124.90	$105.89	9
New Mexico	205	$146.45	$117.69	9
Nevada	193	$165.39	$124.62	9
New Jersey	170	$207.68	$144.39	10
Arkansas	163	$127.60	$112.14	7
Hawaii	142	$187.45	$141.01	6
Delaware	142	$137.46	$105.36	6
District of Columbia	101	$149.94	$105.11	2
South Dakota	99	$114.07	$91.21	6
West Virginia	90	$145.98	$115.36	5
Montana	88	$133.70	$106.13	3
Maine	60	$114.88	$94.20	3
Vermont	59	$135.03	$103.05	2
New Hampshire	58	$141.51	$107.34	3
Connecticut	57	$167.11	$118.01	3
ZZ	57	$134.44	$105.13	1
Minnesota	42	$183.72	$145.26	2
Guam	26	$242.95	$190.36	1
Puerto Rico	25	$129.66	$104.95	1
North Dakota	17	$129.14	$105.03	1

Related codes

11602Removal of cancer skin growth of body$124.23
11603Removal of cancer skin growth of body$145.33
11622Removal of cancer skin growth of scalp$140.18
11604Removal of cancer skin growth of body$207.87
11606Removal of cancer skin growth of body$351.85
11643Removal of cancer skin growth of face$186.77
11641Removal of cancer skin growth of face$146.08
11623Removal of cancer skin growth of scalp$165.51
11601Removal of cancer skin growth of body$150.65
11644Removal of cancer skin growth of face$292.35
11646Removal of cancer skin growth of face$427.86
11621Removal of cancer skin growth of scalp$153.64

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.