CPT 11104 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 11104 by major payers:
$140.32
$162.65
$160.98
$217.80
| 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 11104 | ||||||
United | 11104 | $228.80 | 1457666562 - JARED HEATON | 810232124 - SCL HEALTH MONTANA | UT | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 11104 | $74.37 | 1649550591 - CHERISE MIZRAHI-LEVI | 562402242 - PHILIP BRUDER, M.D., P.C. | FL | Dermatology Physician (207N00000X) |
United | 11104 | $64.41 | 1144269440 - JEFFREY WHITWORTH | 223812197 - (NJ) ATLANTIC DERMATOLOGY ASSOCIATES | NJ | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 11104 | $159.63 | 1194713016 - DANIEL RABB | 743029994 - (GA) METRODERM, P.C. | GA | Dermatology Physician (207N00000X) |
United | 11104 | $156.61 | 1295351120 - NICOLE AMRHEIN | 571101919 - (SC) LESLY S DAVIDSON, MD, PA | SC | Dermatology Physician (207N00000X) |
United | 11104 | $127.45 | 1285669077 - ERIC BAUM | 204857035 - GULF COAST DERMATOLOGY, P.A. | AL | Specialist (174400000X) |
United | 11104 | $172.38 | 1780028332 - MICHAEL SCHOWALTER | 311551899 - (WV) BECKLEY DERMATOLOGY, INC. | IL | Dermatology Physician (207N00000X) |
United | 11104 | $103.06 | 1851611164 - VENESSA PENA-ROBICHAUX | 550853118 - CENTRAL TEXAS COMMUNITY HEALTH CENTERS | TX | Dermatology Physician (207N00000X) |
United | 11104 | $106.06 | 1740385061 - PATRICIA MATHEIS | 264410827 - (NC) WAKE FOREST DERMATOLOGY | NC | Specialist (174400000X) |
United | 11104 | $157.97 | 1477818938 - LAUREN KELLER | 822938015 - (CA) PACIFIC SKIN INSTITUTE | CA | Dermatology Physician (207N00000X) |
United | 11104 | $196.33 | 1982100293 - ASHA GOWDA | 873323847 | MA | Dermatology Physician (207N00000X) |
United | 11104 | $134.05 | 1295148773 - JENNA LESTER | 943281660 | CA | Dermatology Physician (207N00000X) |
United | 11104 | $183.86 | 1992209472 - JACE RICKSTREW | 481145139 - (KS) HEARTLAND DERMATOLOGY AND SKIN CANCER CENTER, P.A. | KS | Dermatology Physician (207N00000X) |
United | 11104 | $380.95 | 1952320962 - ERIC HUANG | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Dermatology Physician (207N00000X) |
United | 11104 | $157.97 | 1235162447 - DAVID MACGREGOR | 204942075 - (CA) DAVID J. MACGREGOR, M.D. A.P.C. | CA | Dermatology Physician (207N00000X) |
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 11104 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11104 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 11104 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 |
|---|---|---|
| 11102-CPT | Low | Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion |
| 11103-CPT | Low | Tangential Biopsy Of Skin (Eg Shave Scoop Saucerize Curette); Each Separate/Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 11104-CPT | Low | Punch Biopsy Of Skin (Including Simple Closure When Performed); Single Lesion |
| 11105-CPT | Low | Punch Biopsy Of Skin (Including Simple Closure When Performed); Each Separate/ Additional Lesion (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 11104. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11104 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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