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See a sample rate comparisonCPT 11004 Fee Schedule
Last Verified: October 2026
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.
Dbrdmt Skin Xtrnl Gent Per, Debridement Of Skin Subcutaneous Tissue Muscle And Fascia For Necrotizing Soft Tissue Infection External Genitalia And Perineum
| 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 |
| Medicare Fee Schedule | View Medicare rates for 11004 |
| Medicaid Fee Schedule | View Medicaid rates for 11004 |
National average reimbursement for CPT 11004 by major payers:
$661.82
$751.24
$748.36
$916.10
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CPT 11004
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Texas International Endoscopy Center, LLC, Texas International Endoscopy Center
$5,554.00Published rateBanner Union Hills Surgery Center LLC
$1,124.00Published rateGeorgia Surgical Center On Peachtree, LLC
Georgia Surgical Center On Peachtree LLC
$829.00Published rateShelby Baptist Ambulatory Surgery Center, LLC, Shelby Ambulatory Surgery At The Physicians Center
Shelby Baptist Ambulatory Surgery Center, LLC
$565.00Published rateZion Ambulatory Center LLC
$48.00Published rate
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See a sample payer proposalCPT 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-CPT | Moderate | Dbrdmt Skin Xtrnl Gent Per, Debridement Of Skin Subcutaneous Tissue Muscle And Fascia For Necrotizing Soft Tissue Infection External Genitalia And Perineum |
| 11005-CPT | Moderate | Dbrdmt Skin Abdominal Wall, Debridement Of Skin Subcutaneous Tissue Muscle And Fascia For Necrotizing Soft Tissue Infection Abdominal Wall With Or Without Fascial Closure |
| 11006-CPT | Moderate | Dbrdmt Skin Xtrnl Gent Per, 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-CPT | Moderate | Rmv Prstc Mtrl Mesh Abd Wall, 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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