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See a sample rate comparisonCPT 11042 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.
Debridement Subcutaneous Tiss, Debridement Subcutaneous Tissue (Includes Epidermis And Dermis If Performed) First 20 Sq Cm Or Less
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 11042 |
| Medicaid Fee Schedule | View Medicaid rates for 11042 |
National average reimbursement for CPT 11042 by major payers:
$135.97
$141.92
$153.22
$104.07
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CPT 11042
5 of 25 sample ratesHigher to lower in this preview
Columbia Medical Center Of Mckinney Subsidiary Lp, Medical City Mckinney
Columbia Medical Center Of Mckinney Subsidiary Lp
$2,000.00Published rateKatherine Gyves-Ray
University Physicians Incorporated
$432.89Published rateMichael Taravella
University Physicians Incorporated
$328.54Published rateAffiliated Physicians & Surgeons, Ltd
Affiliated Physicians Surgeons Ltd
$179.00Published rateSurgicenter Of Baltimore LLC, Surgicenter Of Baltimore
Surgicenter Of Baltimore LLC
$58.00Published rate
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See a sample payer proposalCPT 11042 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11042 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 11042 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 Eczem, 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 Tiss, Debridement Subcutaneous Tissue (Includes Epidermis And Dermis If Performed) First 20 Sq Cm Or Less |
| 11045-CPT | Low | Dbrdmt Subq Tiss Each Addl, 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 |
| 11046-CPT | Low | Dbrdmt Musc Fsca Ea Addl, Debridement Muscle And Or Fascia Includes Epidermis Dermis And Subcutaneous Tissue 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 11042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11042 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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