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 |
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 | $755.18 | 1922012780 - AMY HAYES | 840398876 - YAMPA VALLEY MEDICAL CENTER | CO | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $757.92 | 1669815320 - KEVIN BOEGEL | 200034003 - TRIA ORTHOPAEDIC CENTER LLC | MN | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $261.13 | 1164686002 - MATTHEW HEPINSTALL | 135562308 - NEW YORK UNIVERSITY | NY | Orthopaedic Surgery Physician (207X00000X) |
United | 11403 | $122.04 | 1629144795 - RAFAEL MARTINEZ | 273584044 - (FL) PULMONARY SLEEP OF TAMPA BAY PL | FL | Pulmonary Disease Physician (207RP1001X) |
United | 11403 | $136.83 | 1992793731 - MICHAEL MARGULIES | 650932856 - (FL) ARTHUR S. COLSKY, M.D., PH.D., P.A. D/B/A SKIN CEN | FL | Dermatology Physician (207N00000X) |
United | 11403 | $172.98 | 1861646267 - MICHAEL BRADSHAW | 261267238 - DERMATOLOGY PROFESSIONALS, INCORPORATED | CA | Dermatology Physician (207N00000X) |
United | 11403 | $357.29 | 1700870433 - INNA KOGAN | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 11403 | $289.03 | 1669037131 - NICOLE ROMAN | 832721424 - EAR NOSE THROAT CARE CENTER LTD | IL | Otolaryngology Physician (207Y00000X) |
United | 11403 | $453.62 | 1811940901 - STUART BRAVERMAN | 956419205 - SANSUM CLINIC | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 11403 | $604.84 | 1356359129 - MAHMOOD ALI | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 11403 | $133.53 | 1629036355 - SIEGEL AND BOSWORTH EAR, NOSE, AND THROAT CENTER, P.A. | 521847067 - SIEGEL AND BOSWORTH EAR, NOSE AND THROAT CENTER, P.A. | MD | Otolaryngology Physician (207Y00000X) |
United | 11403 | $204.93 | 1154366011 - JEFFREY DRAYER | 203325000 - LA LASER | CA | Dermatology Physician (207N00000X) |
United | 11403 | $264.99 | 1497884993 - HAROLD NEW | 621388079 - HOLSTON MEDICAL GROUP, INC. | VA | Dermatology Physician (207N00000X) |
United | 11403 | $284.67 | 1225361736 - MILAGROS FERNANDEZ VAZQUEZ | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Surgery Physician (208600000X) |
United | 11403 | $218.36 | 1205831906 - JEROME SUGAR | 60979266 - (CT) EAR NOSE THROAT ASSOCIATES OF WATERBURY PC | FL | Otolaryngology Physician (207Y00000X) |
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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