CPT 11404 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 11404 by major payers:
$244.97
$275.63
$289.28
$361.17
| 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 11404 | ||||||
United | 11404 | $370.00 | 1124071550 - ANDERSEN EYE SURGERY CENTER, LLC | 205044851 - (MI) ANDERSEN EYE SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1282.00 | 1881134815 - PORT JEFFERSON ASC, LLC | 371794376 - (NY) PORT JEFFERSON ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1258.00 | 1336142413 - TEXAN AMBULATORY SURGERY CENTER, LP | 331058382 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $565.00 | 1649791641 - NORTHEAST ATLANTA VASCULAR CARE, LLC | 453857751 - (GA) NORTHEAST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $575.00 | 1083382154 - TRI-CITY SURGICAL CENTERS, LLC | 825357044 - (AZ) TRICITY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $683.00 | 1750414983 - ROCKLEDGE SURGERY CENTER, INC. | 522098503 - (MD) ROCKLEDGE SURGERY CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1258.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $773.00 | 1740424944 - GASTRO CARE, LLC | 263402953 - (OH) GASTRO CARE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1500.00 | 1184009326 - AMBULATORY CENTER FOR ENDOSCOPY, LLC, HUDSON BERGEN ENDO-SURGICAL CENTER | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $850.00 | 1902431646 - CENTRAL OHIO ENDOSCOPY CENTER, LLC | 311674561 - (OH) CENTRAL OHIO ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1661.00 | 1639553779 - UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC., M HEALTH CLINICS AND SURGERY CENTER | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $463.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $1629.00 | 1881789964 - NEW LEXINGTON CLINIC, PSC, LEXINGTON CLINIC AMBULATORY SURGERY CENTER | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $450.00 | 1245201425 - ANDRE J GOLINO MD AND ASSOCIATES PA, PALM BEACH EYE CLINIC | 592348880 - (FL) ANDRE J GOLINO MD AND ASSOCIATES PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11404 | $675.00 | 1962070896 - OAK ASC, LLC | 833101804 - (IL) OAK ASC LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 11404 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11404 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 11404 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 | Low | Debridement; Subcutaneous Tissue (Includes Epidermis And Dermis If Performed); First Each 20 Sq Cm Or Less |
| 11043 | 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 | 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) |
| 11404 | Moderate | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Trunk Arms Or Legs; Excised Diameter 3.1 Cm To 4.0 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 11404. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11404 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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