CPT 11055 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 | • 11 - Office • None |
| Common Modifiers | • None • Q8 - Two Class B Findings • Q9 - One Class B and Two Class C Findings |
| Complexity Level | Low |
National average reimbursement for CPT 11055 by major payers:
$67.07
$70.60
$78.40
$103.36
| 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 11055 | ||||||
United | 11055 | $100.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $531.00 | 1053453134 - ADVANCED SURGICAL CONCEPTS LLC | 331035210 - (LA) ADVANCED SURGICAL CONCEPTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $705.00 | 1154199859 - WATSON CLINIC ASC, LLC | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $325.00 | 1700974995 - THE NEW JERSEY CENTER FOR EAR, NOSE AND THROAT DISORDERS, P.C. | 202822342 - (NJ) THE NEW JERSEY CENTER FOR EAR NOSE AND THROAT DISORDERS PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $531.00 | 1740328947 - ENDOSCOPY CONSULTANTS, LLC | 510425612 - (GA) ENDOSCOPY CONSULTANTS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $92.00 | 1386681161 - SUNCOAST SPECIALTY SURGERY CENTER, LLLP | 204570672 - (FL) SUNCOAST SPECIALTY SURGERY CENTER LLLP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $127.00 | 1891184826 - SURGICAL CENTER OF NORTH FLORIDA, LLC, SURGICAL CENTER OF NORTH FLORIDA | 463936705 - (FL) SURGICAL CENTER OF NORTH FLORIDA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $248.00 | 1023074291 - ARIZONA EYE INSTITUTE & COSMETIC LASER CENTER LLC | 860950533 - (AZ) ARIZONA EYE INSTITUTE COSMETIC LASER CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $1543.00 | 1780613521 - LITCHFIELD HILLS SURGERY CENTER | 562441789 - (CT) LITCHFIELD HILLS SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $531.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $90.00 | 1346233905 - AMBULATORY SURGERY CENTER AT INDIANA EYE CLINIC LLC | 352129461 - (IN) AMBULATORY SURGERY CENTER AT INDIANA EYE CLINIC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $555.00 | 1689664906 - PEDIATRIC SURGERY CENTERS, LLC | 201711553 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $678.00 | 1871575043 - AMBULATORY SURGERY CENTER OF COOL SPRINGS LLC, VANDERBILT SURGERY CENTER COOL SPRINGS | 621809227 - (TN) AMBULATORY SURGERY CENTER OF COOL SPRINGS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $489.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11055 | $1446.00 | 1013227248 - TUSCAN SURGERY CENTER AT LAS COLINAS, LLC, TUSCAN SURGERY CENTER AT LAS COLINAS | 273578014 | TX | 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 11055 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11055 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 11055 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) |
| 11042-CPT | Low | Debridement; Subcutaneous Tissue (Includes Epidermis And Dermis If Performed); First Each 20 Sq Cm Or Less |
| 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 |
| 11055-CPT | Low | Paring/Cutting Benign Hyperkeratotic Lesion (Eg Corn/Callus); Single |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11055 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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