CPT 11313 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 • XS - Separate Structure • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
National average reimbursement for CPT 11313 by major payers:
$191.76
$221.37
$217.28
$290.94
| 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 11313 | ||||||
United | 11313 | $271.00 | 1538389812 - IRONBOUND ENDO SURGICAL CENTER, INC. | 223651393 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $671.00 | 1558344846 - ALGONQUIN ROAD SURGERY CENTER, LLC | 364337493 - (IL) ALGONQUIN ROAD SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $100.00 | 1306187554 - EYE SURGERY CENTER OF WEST GEORGIA LLC | 455011801 - (GA) EYE SURGERY CENTER OF WEST GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $565.00 | 1114965803 - ADVANCED ENDOSCOPY & SURGICAL CENTER LLC, ADVANCED ENDOSCOPY & SURGICAL CENTER | 113660090 - (NJ) ADVANCED ENDOSCOPY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $688.00 | 1124498357 - ENDOSCOPY CENTER OF INLAND EMPIRE LLC | 474733900 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $665.00 | 1174873780 - YORKVILLE ENDOSCOPY, LLC | 460857425 - (NY) YORKVILLE ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $350.00 | 1700887155 - TEXAS MIDWEST SURGERY CENTER, LLC | 752800127 - (TX) TEXAS MIDWEST SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $175.00 | 1194283267 - GEORGIA INTERVENTIONAL PAIN | 832213387 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $70.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 470920340 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $600.00 | 1477792828 - PRECISION SURGICENTER LLC | 262185162 - (CA) PRECISION SURGICENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $792.00 | 1972570117 - METHODIST MEDICAL CENTER ASC LP, METHODIST AMBULATORY SURGERY CENTER MEDICAL CENTER | 731713543 - (TX) METHODIST MEDICAL CENTER ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $506.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $116.00 | 1528643285 - SUMMIT HEALTH PARTNERS LLC, WESTERN CAROLINA SURGERY CENTER | 812722973 - (NC) SUMMIT HEALTH PARTNERS LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $1886.00 | 1447489695 - AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, L.L.C., VIRTUA CENTER FOR SURGERY | 208643005 - (NJ) AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11313 | $164.00 | 1649501073 - SHORE HEALTH SYSTEM, INC., SHORE HEALTH SYSTEM SURGERY CENTER | 520610538 - (MD) SHORE HEALTH SYSTEM INC | MD | 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 11313 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11313 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 11313 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 | Low | Debridement; Subcutaneous Tissue (Includes Epidermis And Dermis If Performed); First Each 20 Sq Cm Or Less |
| 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 |
| 11310 | Low | Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Lesion Diameter 0.5 Cm Or Less |
| 11313 | Low | Shaving Of Epidermal Or Dermal Lesion, Single Lesion, Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Lesion Diameter Over 2.0 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11313. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11313 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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