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 | Low |
| Medicare Fee Schedule | View Medicare rates for 11401 |
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 | $307.39 | 1952538431 - METHODIST MCKINNEY HOSPITAL LLC | 208847736 - (TX) METHODIST MCKINNEY HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $125.91 | 1811991714 - EDWARD ANGLIN | 720703150 - HIGHLAND CLINIC, APMC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $1159.00 | 1093708679 - ASCENSION PROVIDENCE | 741109636 - (TX) ASCENSION PROVIDENCE | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $424.00 | 1962437681 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER-PROFESSIONAL | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 11401 | $694.53 | 1568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $159.36 | 1376531319 - GERARD MURTAGH | 721111762 - (LA) BONE & JOINT CLINIC OF B.R., INC. | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $809.00 | 1538174347 - LCMC HEALTH HOLDINGS INC, EAST JEFFERSON GENERAL HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 11401 | $748.00 | 1720118102 - CENTRAL LOUISIANA AMBULATORY SURGICAL CENTER LLC | 264732898 - (LA) CENTRAL LOUISIANA SURGICAL HOSPITAL, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11401 | $413.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11401 | $113.12 | 1780853127 - MATTHEW LAFLEUR | 452419394 | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11401 | $1181.00 | 1104976703 - TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | 752771437 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | TX | General Acute Care Hospital (282N00000X) |
United | 11401 | $150.00 | 1235161043 - IBERIA ORTHOPEDIC GROUP A PROFESSIONAL CORPORATION, THE IBERIA ORTHOPEDIC GROUP | 720807094 - (LA) IBERIA ORTHOPEDIC GROUP A PROFESSIONAL CORPORATION | LA | Orthopaedic Surgery Physician (207X00000X) |
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 | 11401 | $723.00 | 1649488511 - TOURO INFIRMARY ANESTHESIA SERVICES | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 11401 | $121.62 | 1770514333 - MALCOLM STUBBS | 261193164 - (LA) MALCOLM J STUBBS MD LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
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-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 |
| 11400-CPT | 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-CPT | 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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