CPT 11011 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 |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 11011 by major payers:
$588.64
$671.40
$676.82
$809.25
| 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 11011 | ||||||
United | 11011 | $500.00 | 1457976383 - VHC-I | 851094630 - (AZ) VHCI | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $650.00 | 1437123270 - EDINA MN OPHTHALMOLOGY ASC LLC, MCCANNEL EYE SURGERY | 200487963 - (MN) EDINA MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $1420.00 | 1528438884 - MCLEAN AMBULATORY SURGERY, LLC | 474966649 - (VA) MCLEAN AMBULATORY SURGERY LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $1158.00 | 1245605633 - HARBOR HEIGHTS SURGERY CENTER, LLC | 473886948 - (MD) HARBOR HEIGHTS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $454.00 | 1285690073 - BIRMINGHAM OUTPATIENT SURGERY CENTER LTD, OUTPATIENT CARECENTER | 630984076 - (AL) BIRMINGHAM OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $520.00 | 1992999775 - SPINE SURGERY CENTER OF EUGENE, LLC | 203303351 - (OR) SPINE SURGERY CENTER OF EUGENE LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $852.00 | 1275878845 - THE SURGERY CENTER OF GREATER NASHUA | 461084049 - (NH) SURGERY CENTER OF GREATER NASHUA | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $425.80 | 1821721739 - CAROLYN COLE | 350593390 - DEACONESS HOSPITAL INC | IN | Medical Physician Assistant (363AM0700X) |
United | 11011 | $287.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $926.76 | 1245298066 - SATYAM TATINENI | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 11011 | $336.00 | 1164697009 - BOX HILL SURGERY CENTER LLC | 262454678 - (MD) BOX HILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $472.00 | 1679022636 - NORTHWEST COMMUNITY FOOT AND ANKLE CENTER LLC | 352567039 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $667.00 | 1891186987 - FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER,LLC | 464426708 - (CO) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTERLLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $475.00 | 1427307578 - HEMLOCK AMBULATORY SURGERY CENTER | 455511791 - (GA) HEMLOCK AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11011 | $1350.00 | 1134665193 - NHPE, LLC, NEW HYDE PARK ENDOSCOPY | 471158058 | 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 11011 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11011 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 11011 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 |
|---|---|---|
| 11010 | Moderate | Debridement Including Removal Of Foreign Material At The Site Of An Open Fracture And/Or An Open Dislocation (Eg, Excis Debridement); Skin And Sub-Q Tissues (Revision 2011) |
| 11011 | Moderate | Debridement Including Removal Of Foreign Material At The Site Of An Open Fracture And/Or An Open Dislocation (Eg, Excisional Debridement); Skin, Subcutaneous Tissue, Muscle Fascia, And Muscle |
| 11012 | Moderate | Debridement Including Removal Of Foreign Material At The Site Of An Open Fracture And/Or An Open Dislocation (Eg, Excisional Debridement); Skin, Subcutaneous Tissue, Muscle Fascia, Muscle, And Bone |
| 11042 | Low | Debridement; Subcutaneous Tissue (Includes Epidermis And Dermis If Performed); First Each 20 Sq Cm Or Less |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11011 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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