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 | Moderate |
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 | $200.00 | 1770537698 - PHYSICIANS SURGERY CENTER OF FLORENCE LLC, PHYSICIANS SURGERY CENTER OF FLORENCE | 431983435 - (SC) QHG OF SOUTH CAROLINA INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $198.92 | 1073874814 - TYLER BRON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | KS | Orthopaedic Surgery Physician (207X00000X) |
United | 11046 | $144.05 | 1215945928 - JOHN LOWERY | 470662290 - (NE) NORTH PLATTE NEBRASKA HOSPITAL CORPORATION | CO | Surgery Physician (208600000X) |
United | 11046 | $151.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $158.41 | 1124314000 - THOMAS MITCHELL | 911352172 - MULTICARE HEALTH SYSTEM | NV | Surgery Physician (208600000X) |
United | 11046 | $115.52 | 1770525719 - EDWARD MEDINA | 463778226 | CO | Surgery Physician (208600000X) |
United | 11046 | $122.41 | 1245590108 - SHIVANSHU MADAN | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Interventional Cardiology Physician (207RI0011X) |
United | 11046 | $88.15 | 1902269764 - KEVIN HARRELL | 721318421 - CHILDRENS HOSPITAL MEDICAL PRACTICE CORP | TN | Surgical Critical Care Physician (2086S0102X) |
United | 11046 | $91.08 | 1891889127 - GORDON LINDBERG | 232700908 - (PA) LEHIGH VALLEY PHYSICIAN GROUP | MI | Surgery Physician (208600000X) |
United | 11046 | $340.00 | 1639431653 - DESERT CLIFFS SURGERY CENTER LLC | 800824134 - (AZ) DESERT CLIFFS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $115.00 | 1669427043 - VANCOUVER EYE CARE PS | 910913651 - (WA) VANCOUVER EYE CARE, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11046 | $257.07 | 1063509198 - KEVIN ESS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | TN | Epilepsy Physician (2084E0001X) |
United | 11046 | $310.63 | 1306005442 - MICHAEL ARNOLD | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Pathology Physician (207ZP0213X) |
United | 11046 | $195.10 | 1205256872 - SARAH PETERSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CA | Obstetrics & Gynecology Physician (207V00000X) |
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 | 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 | 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 | 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 | 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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