CPT 11005 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 • 59 - Distinct Procedural Service • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
National average reimbursement for CPT 11005 by major payers:
$939.45
$1,016.18
$1,004.13
$1,253.76
| 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 11005 | ||||||
United | 11005 | $456.00 | 1265624696 - CENTRAL OHIO UROLOGY SURGERY CENTER, LLC | 261240704 - (OH) CENTRAL OHIO UROLOGY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $2172.00 | 1750347472 - BAYLOR SURGICARE AT NORTH DALLAS, LLC, BAYLOR SCOTT & WHITE SURGICARE-NORTH DALLAS | 752900902 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $429.00 | 1942318498 - DIGESTIVE DISEASE CENTER | 880291959 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $555.00 | 1679656714 - LITTLETON DAY SURGERY CENTER LLC | 232731319 - (CO) LITTLETON DAY SURGERY CENTER | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $1146.00 | 1508438375 - BSC REID PARK LLC | 870858924 - (AZ) BSC REID PARK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $403.00 | 1902095417 - PERIMETER SURGICAL CENTER INC | 260698992 - (OH) PERIMETER SURGICAL CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $405.00 | 1154301240 - ENDOSCOPY CENTER OF WASHINGTON DC LP, THE ENDOSCOPY CENTER OF WASHINGTON, D.C. | 621543524 - (DC) ENDOSCOPY CENTER OF WASHINGTON DC LP | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $1126.00 | 1700838471 - SANTA CRUZ SURGERY CENTER | 770194916 - (CA) SANTA CRUZ SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $550.00 | 1629078043 - NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC, OVERLAND PARK SURGERY CENTER | 364130546 - (KS) NOVAMED EYE SURGERY CENTER OF OVERLAND PARK LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $1621.00 | 1720388465 - WEST ASC, LLC, CAMILLUS SURGERY CENTER | 273166743 - (NY) WEST ASC, LLC DBA CAMILLUS SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $455.00 | 1972141455 - FALLSGROVE ENDOSCOPY CENTER, LLC | 842186338 - (MD) FALLSGROVE ENDOSCOPY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $360.00 | 1013011162 - BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP | 593213374 - (FL) BAY AREA ENDOSCOPY CENTER LIMITED PARTNERSHIP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $2847.00 | 1063720365 - WASATCH FRONT SURGERY CENTER LLC | 800612279 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $1049.00 | 1942715826 - SAFETY HARBOR ASC COMPANY LLC, SAFETY HARBOR SURGERY CENTER | 320547161 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11005 | $240.00 | 1588046361 - NIAGARA ASC, LLC, ASC OF NIAGARA | 463471081 - (NY) NIAGARA ASC LLC | NY | 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 11005 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11005 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 11005 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 | Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft Tissue Infection; External Genitalia And Perineum |
| 11005-CPT | Moderate | Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft Tissue Infection; Abdominal Wall, With Or Without Fascial Closure |
| 11006-CPT | 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-CPT | 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 11005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11005 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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