CPT 11406 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 11406 by major payers:
$337.22
$390.36
$414.57
$502.88
| 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 11406 | ||||||
United | 11406 | $3607.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $296.00 | 1457502239 - APOLLO SURGERY CENTER LLC | 261387775 - (FL) APOLLO SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1749.00 | 1730876210 - MEDICAL CITY SURGERY CENTER NORTH TEXAS, LLC | 923326615 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1631.00 | 1942292545 - CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C. | 141819902 - (NY) CAPITAL REGION AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1475.00 | 1457725392 - THE ENDOSCOPY CENTER OF QUEENS INC | 262427823 - (NY) THE ENDOSCOPY CENTER OF QUEENS INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $815.00 | 1619933264 - SALEM SURGERY CENTER, LLC | 742462470 - (OR) SALEM SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $703.00 | 1487628301 - SAN ANTONIO TX ENDOSCOPY ASC LP, SAN ANTONIO GASTROENTEROLOGY ENDOSCOPY CENTER | 200075829 - (TX) SAN ANTONIO TX ENDOSCOPY ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1267.00 | 1245436823 - EASTERN MASSACHUSETTS SURGERY CENTER LLC, EASTERN MASSACHUSETTS SURGERY CENTER | 260393450 - (MA) EASTERN MASSACHUSETTS SURGERY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $711.00 | 1427015999 - WEST SHORE SURGERY, LTD, WEST SHORE SURGERY CENTER, LTD | 251821415 - (PA) WEST SHORE SURGERY CENTER, LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $875.00 | 1053481960 - AESTHETIC ASSOCIATES INC., P.S., SEATTLE FACIAL PLASTIC SURGERY CENTER | 911650765 - (WA) AESTHETIC ASSOCIATES INC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $649.00 | 1477526689 - THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC, BLUE RIDGE SURGERY CENTER | 621821015 - (SC) THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $3105.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $347.00 | 1033223367 - SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | 201379958 - (FL) SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $667.00 | 1508845942 - ENDOSCOPY CENTER OF KNOXVILLE LP, THE ENDOSCOPY CENTER WEST | 621512837 - (TN) ENDOSCOPY CENTER OF KNOXVILLE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1275.00 | 1003553645 - CYPRESS AMBULATORY SURGERY CENTER, LLC, CURRENCY CIRCLE SURGERY CENTER | 823481913 | FL | 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 11406 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11406 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 11406 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) |
| 11406-CPT | Moderate | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Trunk Arms Or Legs; Excised Diameter Over 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 11406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11406 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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