CPT 11305 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 • 99 - Other POS |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 11305 by major payers:
$101.81
$117.51
$122.44
$161.67
| 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 11305 | ||||||
United | 11305 | $318.00 | 1356080642 - LEGENT OUTPATIENT SURGERY SINGING HILLS, LLC, LEGENT OUTPATIENT SURGERY SINGING HILLS | 861677359 - (TX) LEGENT OUTPATIENT SURGERY SINGING HILLS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $404.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $487.00 | 1861743601 - FLUSHING ENDOSCOPY CENTER, LLC | 274675522 - (NY) FLUSHING ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $135.00 | 1407334881 - BEACON ORTHOPAEDIC SURGERY CENTER, BEACON AMBULATORY SURGERY CENTER | 311800570 - (OH) BEACON ORTHOPAEDICS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $106.00 | 1851342430 - BEL AIR AMBULATORY SURGICAL CENTER ,L.L.C. | 522125649 - (MD) BEL AIR AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $100.00 | 1871868422 - PARAMOUNT SURGERY CENTER, LLC, THE CENTER FOR SPECIALIZED SURGERY | 452232749 - (FL) PARAMOUNT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $402.00 | 1295088292 - CADENCE AMBULATORY SURGERY CENTER, LLC | 800838376 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $150.00 | 1619935483 - OUTPATIENT SURGERY CENTER OF HILTON HEAD | 611409045 - (SC) OUTPATIENT SURGERY CENTER OF HILTON HEAD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $566.00 | 1730713439 - FLORIDA SPRINGS SURGERY CENTER LLC | 832895293 - (FL) FLORIDA SPRINGS SURGERY CENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $673.00 | 1275281370 - MASS GENERAL BRIGHAM AMSURG INC. | 854372153 - (NH) MASS GENERAL BRIGHAM INCORPORATED | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $123.00 | 1174233522 - THOMAS EYE SURGERY CENTER OF FAYETTE | 881476592 - (GA) THOMAS EYE SURGERY CENTER OF FAYETTE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $530.00 | 1710688627 - BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | 922359229 - (KY) BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $134.00 | 1093121196 - GULF COAST OUTPATIENT SURGERY CENTER, LLC | 640935301 - (MS) GULF COAST OUTPATIENT SURGERY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $149.00 | 1750343083 - LEXINGTON SURGERY CENTER LTD | 611028180 - (KY) LEXINGTON SURGERY CENTER LTD | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11305 | $50.00 | 1063701977 - NEW VISION SURGICAL CENTER, LLC | 270354247 - (FL) NEW VISION SURGICAL CENTER LLC | FL | 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 11305 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11305 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 11305 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 |
|---|---|---|
| 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 |
| 11305-CPT | Low | Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Scalp, Neck, Hands, Feet, Genitalia; Lesion Diameter 0.5 Cm Or Less |
| 11306-CPT | Low | Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Scalp,Neck, Hands, Feet, Genitalia; Lesion Diameter 0.6 To 1.0 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11305 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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