CPT 11403 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 |
| Medicare Fee Schedule | View Medicare rates for 11403 |
National average reimbursement for CPT 11403 by major payers:
$210.11
$242.67
$255.40
$319.15
| 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 11403 | ||||||
United | 11403 | $440.82 | 1285165142 - MICHAEL CONNOR | 912018691 - RADIANTCARE PHYSICIANS, PLLC | WA | Radiation Oncology Physician (2085R0001X) |
United | 11403 | $305.28 | 1710113345 - DAVID GALLEGOS | 850106941 - ST VINCENT HOSPITAL | TN | Otolaryngology Physician (207Y00000X) |
United | 11403 | $592.70 | 1629050216 - DANIEL HOLUB | 391101566 - ORTHOPAEDIC ASSOCIATES OF WISCONSIN, S.C. | WI | Orthopaedic Surgery Physician (207X00000X) |
United | 11403 | $412.09 | 1306803051 - NATIA ESIASHVILI | 582030692 - EMORY UNIVERSITY | GA | Radiation Oncology Physician (2085R0001X) |
United | 11403 | $188.26 | 1386604106 - BETH HUMMER | 880217865 - RADIATION ONCOLOGY ASSOCIATES CHARTERED DRS CAMPBELL & HUMMER | NV | Radiation Oncology Physician (2085R0001X) |
United | 11403 | $284.67 | 1225361736 - MILAGROS FERNANDEZ VAZQUEZ | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Surgery Physician (208600000X) |
United | 11403 | $290.17 | 1275569212 - EDWARD STEINER | 232730785 - WELLSPAN MEDICAL GROUP | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $125.45 | 1700083763 - MERSHAD HAGIGI | 270352762 - DR. LUIS F. LUNA, MD LLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $453.62 | 1811940901 - STUART BRAVERMAN | 956419205 - SANSUM CLINIC | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $325.27 | 1598743601 - MA KATRINA DY | 300761298 - (MA) NESC MACIPA LLC | FL | Dermatology Physician (207N00000X) |
United | 11403 | $301.94 | 1700106200 - YOUSAF AWAN | 520591657 - ST AGNES HEALTHCARE INC | MA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $263.27 | 1316972201 - DAVID WONG | 273123104 - DIRECT DERMATOLOGY PROFESSIONALS PC | CA | Dermatology Physician (207N00000X) |
United | 11403 | $894.61 | 1508251422 - TIMOTHY IAFE | 611729294 - REGENTS OF THE UNIVERSITY OF CALIFORNIA | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $282.75 | 1710907662 - ROGER WILEY | 540506332 - CARILION MEDICAL CENTER | VA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $225.35 | 1669621785 - BRANDON FRYE | 471980839 - (FL) BLACKSTONE HAND CENTER LLC | FL | Orthopaedic Hand Surgery Physician (207XS0106X) |
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 11403 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11403 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 11403 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) |
| 11403-CPT | Moderate | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Trunk Arms Or Legs; Excised Diameter 2.1 Cm To 3.0 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 11403. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11403 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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