What is CPT Code 11401 used for?

CPT Code 11401 is used by healthcare providers to document and receive reimbursement for the excision of a benign lesion, including margins, from the trunk, arms, or legs, with an excised diameter of 0.6 to 1.0 cm.

How does PayerPrice help with CPT 11401 rates?

PayerPrice allows users to benchmark their current rates against market averages, prospect for new business using fee schedules, and integrate real-time payer data into workflows to keep fee schedules up-to-date for CPT 11401 and other codes.

What is price transparency in healthcare?

Price transparency in healthcare refers to the federal rules that require insurers to publish their exact negotiated rates. PayerPrice displays this raw data directly from insurers' files, providing public access to this information.

How can I find out the cost of a medical procedure or service before I receive it?

To find out the cost of a medical procedure or service tailored to your specific situation, it's recommended to use price transparency tools. For specific fee schedules based on CPT codes and your location, you can utilize platforms like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an estimated cost.

What is a CPT code and how does it relate to healthcare costs?

A CPT (Current Procedural Terminology) code is a five-digit code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are crucial for billing and determine the cost of specific procedures. When looking up prices for healthcare services, you'll often need the CPT code to get accurate pricing information, for example, when using a tool like Payerprice to search for a specific service in your location.

What is healthcare price transparency?

Healthcare price transparency refers to initiatives aimed at making the costs of medical services clear and accessible to consumers before they receive care. The goal is to empower patients to make informed decisions by allowing them to compare prices among different providers and understand their potential financial obligations.

Why is it often difficult to get clear pricing for healthcare services?

Getting clear pricing for healthcare services can be difficult due to several factors, including the complexity of insurance contracts, varying provider charges, the bundling of services, and the lack of standardized upfront price disclosure across all providers. Many healthcare systems have historically not provided readily accessible pricing information, making it challenging for patients to understand their financial responsibility.

What is the difference between Payerprice and CMS regarding price lookup tools for consumers?

When looking for specific healthcare fee schedule information for consumers, Payerprice and CMS serve different primary functions. Payerprice offers a fee schedule lookup tool specifically designed for users to search with CPT codes and specific locations, providing access to commercial payer fee schedules. CMS (Centers for Medicare & Medicaid Services), on the other hand, primarily sets reimbursement rates for Medicare and Medicaid services. While CMS publishes some pricing data related to government programs, Payerprice is a more direct and comprehensive resource for consumers and providers looking up commercial fee schedules based on CPT codes and specific geographical areas.

CPT 11401 Fee Schedule

Q: What factors affect CPT 11401 fee schedules?

Factors affecting fee schedules include 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), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: September 2026

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.

Exc Tr Ext B9 Marg 0 6 1 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 6 To 1 0 Cm

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
Medicaid Fee Schedule	View Medicaid rates for 11401

National average reimbursement for CPT 11401 by major payers:

$168.10

$188.64

$200.94

$175.11

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 11401.

CPT 11401

5 of 25 sample ratesHigher to lower in this preview

Texas Health Presbyterian Hospital Kaufman
TXGeneral Acute Care HospitalNPI 1104976703Tax ID 75-2771437
$1,181.00Published rate
Cumberland Surgical Hospital Of San Antonio LLC, Legent Orthopedic & Spine
TXGeneral Acute Care HospitalNPI 1568848059Tax ID 47-4612520
$694.53Published rate
Methodist Mckinney Hospital LLC
TXGeneral Acute Care HospitalNPI 1952538431Tax ID 20-8847736
$307.39Published rate
Gerard Murtagh
Bone & Joint Clinic Of B.R., Inc.
LAOrthopaedic Surgery PhysicianNPI 1376531319Tax ID 72-1111762
$159.36Published rate
Matthew Lafleur
LAOrthopaedic Surgery PhysicianNPI 1780853127Tax ID 45-2419394
$113.12Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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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
11400-CPT	Low	Exc Tr Ext B9 Marg 0 5 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 5 Cm Or Less
11401-CPT	Low	Exc Tr Ext B9 Marg 0 6 1 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 6 To 1 0 Cm
11402-CPT	Low	Exc Tr Ext B9 Marg 1 1 2 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 1 1 To 2 0 Cm
11403-CPT	Moderate	Exc Tr Ext B9 Marg 2 1 3cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 2 1 To 3 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 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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CPT 11401 Fee Schedule

Texas Health Presbyterian Hospital Kaufman

Cumberland Surgical Hospital Of San Antonio LLC, Legent Orthopedic & Spine

Methodist Mckinney Hospital LLC

Gerard Murtagh

Matthew Lafleur