CPT 11046 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 | • 99 - Other POS • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
National average reimbursement for CPT 11046 by major payers:
$82.06
$91.12
$91.57
$126.17
| 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 11046 | ||||||
United | 11046 | $175.00 | 1508574518 - AMBULATORY SURGERY CENTER OF CENTRALIA | 883961418 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $122.41 | 1457707630 - FRANK FERRAIOLI | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Emergency Medicine Physician (207P00000X) |
United | 11046 | $122.41 | 1477963270 - SUSAN WCISLAK | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | AZ | Surgery Physician (208600000X) |
United | 11046 | $521.00 | 1699702050 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON BELLEVUE ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $122.41 | 1487920997 - CALEY COPELAND | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Internal Medicine Physician (207R00000X) |
United | 11046 | $164.00 | 1366181778 - AXION SPINE OUTPATIENT SURGERY CENTER | 881709019 - (GA) AXION SPINE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $109.08 | 1083144026 - ROBERT PRIDE | 841154255 - (CO) WESTERN SURGICAL CARE, PC | CO | Surgery Physician (208600000X) |
United | 11046 | $257.07 | 1538326301 - ROBERT BISHOP | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 11046 | $198.92 | 1033673157 - ANN ABROMAITIS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Adult Health Nurse Practitioner (363LA2200X) |
United | 11046 | $97.40 | 1275896508 - DMITRIY RYBITSKIY | 363907436 - ROCKFORD HEALTH PHYSICIANS | NY | Surgical Critical Care Physician (2086S0102X) |
United | 11046 | $198.92 | 1922655919 - CHARLOTTE VO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Advanced Practice Midwife (367A00000X) |
United | 11046 | $244.07 | 1144872680 - SARA SKLUZACEK | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Surgical Physician Assistant (363AS0400X) |
United | 11046 | $195.10 | 1962437533 - MARK SPITZ | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Epilepsy Physician (2084E0001X) |
United | 11046 | $310.63 | 1306005442 - MICHAEL ARNOLD | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Pathology Physician (207ZP0213X) |
United | 11046 | $195.10 | 1942642418 - ALLAN SCHMELZEL | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Surgical Physician Assistant (363AS0400X) |
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 11046 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11046 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 11046 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) |
| 11012-CPT | 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 |
| 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 |
| 11046-CPT | Low | 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 11046. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11046 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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