CPT 11004 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
National average reimbursement for CPT 11004 by major payers:
$661.82
$751.24
$748.36
$933.21
| 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 11004 | ||||||
United | 11004 | $1064.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $1141.00 | 1598419509 - UOI EAST BAY SURGERY CENTER LLC | 873506992 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $460.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $4893.00 | 1952331092 - MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | 203233617 - (TX) MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $429.00 | 1316919574 - CHEVY CHASE ASC LLC, CHEVY CHASE ENDOSCOPY CENTER | 621666144 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $680.00 | 1649893934 - SIMI VALLEY SURGERY CENTER INC | 841997544 - (CA) SIMI VALLEY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $779.00 | 1306353586 - SDG CASTLE ROCK ENDOSCOPY CENTER | 823765778 - (CO) SDG CASTLE ROCK ENDOSCOPY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $1064.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $983.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $601.00 | 1912675513 - SUNRISE SURGERY CENTER LLC | 824678882 - (NY) SUNRISE SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $678.00 | 1497788277 - PACIFIC EYE SURGERY CENTER, PACIFIC SURGERY CENTER | 954200314 - (CA) PACIFIC EYE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $712.00 | 1306989249 - MEDICAL ARTS SURGERY CENTER LLC | 208261564 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $212.00 | 1639176183 - BERKS CENTER FOR DIGESTIVE HEALTH, LP | 233068912 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $575.00 | 1447442348 - TIMOTHY P. CAREY M.D. INC. P.S. | 910870414 - (WA) TIMOTHY P CAREY MD INC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11004 | $4893.00 | 1407165772 - MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC, MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY | 273520409 | TX | 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 11004 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11004 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 11004 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 |
|---|---|---|
| 11004 | Moderate | Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft Tissue Infection; External Genitalia And Perineum |
| 11005 | Moderate | Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft Tissue Infection; Abdominal Wall, With Or Without Fascial Closure |
| 11006 | Moderate | Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft Tissue Infection; External Genitalia, Perineum And Abdominal Wall, With Or Without Fascial Closure |
| 11008 | Moderate | Removal Of Prosthetic Material Or Mesh Abdominal Wall For Infection (Eg. For Chronic Or Recurrent Mesh Infection Or Necrotizing Soft Tissue Infection) (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 11004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11004 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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