CPT 11043 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 | • None • 99 - Other POS |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GW - Condition not related to the patient's terminal condition |
| Complexity Level | Moderate |
National average reimbursement for CPT 11043 by major payers:
$275.92
$303.07
$304.49
$377.54
| 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 11043 | ||||||
United | 11043 | $225.00 | 1962938332 - BANNER UNION HILLS SURGERY CENTER LLC | 901164193 - (AZ) BANNER UNION HILLS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11043 | $240.08 | 1760554521 - MARCIA MOORE | 900733283 | CO | Surgery Physician (208600000X) |
United | 11043 | $805.15 | 1932498870 - MEGAN SOOHOO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 11043 | $623.03 | 1801915822 - DANIEL POLLYEA | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Hematology & Oncology Physician (207RH0003X) |
United | 11043 | $529.28 | 1982641494 - SLOBODAN JAZAREVIC | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | FL | Trauma Surgery Physician (2086S0127X) |
United | 11043 | $778.79 | 1023363751 - PETTER BJORNSTAD | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | WA | Pediatric Endocrinology Physician (2080P0205X) |
United | 11043 | $383.41 | 1548286693 - FORREST MOORE | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Trauma Surgery Physician (2086S0127X) |
United | 11043 | $383.41 | 1730130337 - LAURA KISSELL | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Vascular Surgery Physician (2086S0129X) |
United | 11043 | $258.58 | 1013108299 - RICHARD ETHRIDGE | 452039847 | CO | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 11043 | $992.35 | 1902117906 - ROBERT DIETZ | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatrics Physician (208000000X) |
United | 11043 | $611.05 | 1437619392 - DAVID SCUDDER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Hospitalist Physician (208M00000X) |
United | 11043 | $175.00 | 1346292372 - SURGERY CENTER PARTNERS. LLC, TIMBERLAKE SURGERY CENTER | 421580803 - (MO) SURGERY CENTER PARTNERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11043 | $611.05 | 1992701411 - ELIZABETH CERIMELE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Certified Registered Nurse Anesthetist (367500000X) |
United | 11043 | $230.00 | 1801825880 - SURGERY CENTER AT RIVER ROAD, LLC, AESTHETIC SURGERY AT HACIENDA DEL SOL | 760824670 - (AZ) SURGERY CENTER AT RIVER ROAD, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11043 | $779.71 | 1437397072 - SARA PRICE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Advanced Practice Midwife (367A00000X) |
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 11043 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11043 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 11043 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 Eczematous Or Infected Skin; Each Additional 10% Of The Body Surface, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) |
| 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 |
| 11043-CPT | Moderate | Debridement; Muscle An/Or Fascia (Includes Epidermis Dermis And Subcutaneous Tissue Muscle And/Or Fascia If Perfomred); First 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 11043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11043 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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