CPT 11056 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 11056 by major payers:
$80.30
$84.32
$91.14
$121.21
| 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 11056 | ||||||
United | 11056 | $304.00 | 1720011042 - PREMIER ORTHOPAEDIC SURGERY CENTER, LLC | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $330.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $51.00 | 1770802555 - FAIRLAWN SURGERY CENTER, LLC | 271762713 - (VA) FAIRLAWN SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $566.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $113.00 | 1053985721 - ENDO SURGICAL CENTER OF KISSIMMEE, PLLC | 844377406 - (FL) ENDO SURGICAL CENTER OF KISSIMMEE PLLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $402.00 | 1295088292 - CADENCE AMBULATORY SURGERY CENTER, LLC | 800838376 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $180.00 | 1629313739 - COLTON CA MULTI ASC LP, PREMIER OUTPATIENT SURGERY CENTER | 461462978 - (CA) COLTON CA MULTI ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $274.00 | 1780689802 - PAIN DIAGNOSTIC AND TREATMENT CENTER LP | 770525632 - (CA) PAIN DIAGNOSTIC AND TREATMENT CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $87.00 | 1225107014 - COMMONWEALTH EYE CLINIC INC | 611140257 - (KY) COMMONWEALTH EYE CLINIC INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $253.00 | 1639164916 - THE SURGERY CENTER AT SACRED HEART MEDICAL PARK, DESTIN, LLC | 562315052 - (FL) THE SURGERY CENTER AT SACRED HEART MEDICAL PARK DESTIN LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $82.00 | 1295824100 - BETTER LIVING ENDOSCOPY CENTER | 640877920 - (MS) BETTER LIVING ENDOSCOPY CENTER | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $87.00 | 1922071315 - SENECA PA ASC LLC, THE SURGERY AND LASER CENTER | 621806254 - (PA) SENECA PA ASC, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $381.00 | 1922255413 - TWIN CITIES AMBULATORY SURGERY CENTER LP, TWIN CITIES SURGERY CENTER | 260839397 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $151.00 | 1437100666 - HEARTLAND CATARACT & LASER SURGERY CENTER, INC., HEARTLAND CATARACT & LASER SURGERY CENTER | 470824936 - (NE) HEARTLAND CATARACT LASER SURGERY CENTER INC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11056 | $200.00 | 1609949551 - NORTHWEST VISION INSTITUTE, PLLC, NORTHWEST LASER AND SURGERY CENTER | 383807987 - (WA) NORTHWEST VISION INSTITUTE, PLLC | WA | 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 11056 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11056 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 11056 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 |
| 11056-CPT | Low | Paring/Cutting Benign Hyperkeratotic Lesion (Eg Corn/Callus); 2-4 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11056 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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