CPT 11401 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 • 51 - Multiple procedures |
| Complexity Level | Moderate |
National average reimbursement for CPT 11401 by major payers:
$168.10
$188.64
$200.94
$250.64
| 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 11401 | ||||||
United | 11401 | $1159.00 | 1093708679 - ASCENSION PROVIDENCE | 741109636 - (TX) ASCENSION PROVIDENCE | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $1571.00 | 1831629526 - EBD BEMC BURLESON, LLC, BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL GRAND PRAIRIE | 364755936 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $150.00 | 1942219894 - MATTHEW WILLIAMS | 263025784 - (LA) LOUISIANA ORTHOPAEDIC SPECIALISTS, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $853.00 | 1538260849 - VALLEY BAPTIST MEDICAL CENTER | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $1065.00 | 1225289499 - LUBBOCK HERITAGE HOSPITAL, LLC., GRACE SURGICAL HOSPITAL | 264021016 - (TX) LUBBOCK HERITAGE HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $591.00 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $150.00 | 1023542339 - BATON ROUGE VASCULAR ACCESS ASC LLC | 814685509 - (LA) BATON ROUGE VASCULAR ACCESS ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11401 | $302.04 | 1851343909 - VICTORIA OF TEXAS LP, DETAR HEALTHCARE SYSTEM | 621754940 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $145.61 | 1255168175 - SOUTHERN SPINE & ORTHOPAEDICS LLC | 994767012 | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $240.19 | 1558656025 - CHRISTOPHER SANCHEZ | 461045337 - (LA) PARADIGM HEALTH SYSTEM | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $1865.00 | 1497796296 - ST FRANCIS HOSPITAL INC, ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 11401 | $682.00 | 1932204427 - NMC OPERATING COMPANY LLC, THE SPINE HOSPITAL OF LOUISIANA | 270059959 - (LA) NMC OPERATING COMPANY, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 11401 | $307.39 | 1952538431 - METHODIST MCKINNEY HOSPITAL LLC | 208847736 - (TX) METHODIST MCKINNEY HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $1475.00 | 1750819025 - NORTH HOUSTON, HCA HOUSTON HEALTHCARE TOMBALL | 821349955 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $688.50 | 1255325817 - MIDLAND COUNTY HOSPITAL DISTRICT, MIDLAND MEMORIAL HOSPITAL | 751584559 - (TX) MIDLAND COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
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 11401 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11401 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 11401 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 |
| 11400 | Low | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Trunk Arms Or Legs; Excised Diameter 0.5 Cm Or Less (Desc Rev 1/1/03) |
| 11401 | Low | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Trunk Arms Or Legs; Excised Diameter 0.6 To 1.0 Cm (Desc Rev 1/1/03) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11401. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11401 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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