CPT 11001 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 11 - Office • 50 - Federally Qualified Health Center • None |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 11001 by major payers:
$28.90
$29.50
$30.40
$41.33
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 11001 | ||||||
United | 11001 | $400.00 | 1346210259 - SURGICARE LLC | 351975122 - (IN) SURGICARE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $534.00 | 1639694797 - UCSD CENTER FOR SURGERY OF ENCINITAS, L.P. | 822326631 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $143.00 | 1588071575 - FOULK ROAD SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $970.00 | 1063720365 - WASATCH FRONT SURGERY CENTER LLC | 800612279 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $100.00 | 1144380593 - SURGERY CENTER OF ALLENTOWN LLC, SURGERY CENTER OF ALLENTOWN | 204532105 - (PA) SURGERY CENTER OF ALLENTOWN | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $54.00 | 1205804697 - GOLDSBORO ENDOSCOPY CENTER INC | 562003095 - (NC) GOLDSBORO ENDOSCOPY CENTER INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $116.00 | 1861485138 - DISCOVER EYE SURGERY CENTER, LLC, EYE SURGERY CENTER - THE CLIFFS | 431909100 - (MO) DISCOVER EYE SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $574.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $627.00 | 1407591902 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $100.00 | 1750313144 - AMBULATORY SURGICAL CARE, LLC | 593082994 - (FL) AMBULATORY SURGICAL CARE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $700.00 | 1295855948 - MAINE EYE CENTER, PA | 10329291 - (ME) MAINE EYE CENTER | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $317.00 | 1902958226 - AMBULATORY SURGERY CENTER OF TUCSON, INC. | 262420656 - (AZ) AMBULATORY SURGERY CENTER OF TUCSON INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $78.00 | 1770551517 - SOUTHERN MARYLAND ENDOSCOPY CENTER | 522315798 - (MD) SOUTHERN MARYLAND ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $574.00 | 1154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC | 833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11001 | $116.00 | 1962531988 - PIEDMONT SURGERY CENTER | 581874926 - (GA) PIEDMONT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 11001 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11001 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 11001 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 11001-CPT | Low | Debridement Of Extensive Eczematous Or Infected Skin; Each Additional 10% Of The Body Surface, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) |
| 11042-CPT | Low | Debridement; Subcutaneous Tissue (Includes Epidermis And Dermis If Performed); First Each 20 Sq Cm Or Less |
| 11043-CPT | Moderate | Debridement; Muscle An/Or Fascia (Includes Epidermis Dermis And Subcutaneous Tissue Muscle And/Or Fascia If Perfomred); First 20 Sq Cm Or Less |
| 11045-CPT | Low | Debridement, Subcutaneous Tissue (Includes Epidermis And Dermis, If Performed); Each Additional 20 Sq Cm, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11001. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11001 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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