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: July 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	Excision-Benign Lesions Procedures on the Skin Surgical Procedures on the Skin, Subcutaneous and Accessory Structures
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

$175.11

Preview provider-level rates for...

For billing codeCPT 11401

Payer	Code	Rate	NPI	Tax ID	State	Specialty
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 Skin, Subcutaneous and Accessory Structures Codes

The CPT 11401 code is part of the Excision-Benign Lesions Procedures on the Skin services used for Surgical Procedures on the Skin, Subcutaneous and Accessory Structures. 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 Tiss, Debridement Subcutaneous Tissue (Includes Epidermis And Dermis If Performed) First 20 Sq Cm Or Less
11043-CPT	Moderate	Dbrdmt Musc Fsca 1st 20, Debridement Muscle And Or Fascia Includes Epidermis Dermis And Subcutaneous Tissue If Performed First 20 Sq Cm Or Less
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

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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