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 | $600.00 | 1255872784 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER | 814079161 | PA | 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 | $1275.00 | 1003553645 - CYPRESS AMBULATORY SURGERY CENTER, LLC, CURRENCY CIRCLE SURGERY CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1233.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $438.00 | 1801849427 - MAIN STREET ASC LLC, OPHTHALMIC ASSOCIATES SURGERY AND LASER CENTER | 383711415 - (PA) MAIN STREET ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $963.00 | 1376605279 - MIDWEST CENTER FOR DAY SURGERY, LLC | 208103522 - (IL) MIDWEST CENTER FOR DAY SURGERY, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1233.00 | 1699777540 - PHYSICIANS SURGERY CENTER OF TEMPE, LLC, PHYSICIANS SURGERY CENTER OF TEMPE | 731538769 - (AZ) PHYSICIANS SURGERY CENTER OF TEMPE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $970.00 | 1104907328 - ANDREWS INSTITUTE ASC LLC | 352274952 - (FL) ANDREWS INSTITUTE ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1798.00 | 1558344846 - ALGONQUIN ROAD SURGERY CENTER, LLC | 364337493 - (IL) ALGONQUIN ROAD SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1222.00 | 1346621893 - NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | 472128570 - (NJ) NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1179.00 | 1356903967 - UNITY LINDEN OAKS SURGERY CENTER | 800798208 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $580.00 | 1053301473 - BAKER AMBULATORY SURGERY CENTER | 710839283 - (AR) BAKER AMBULATORY SURGERY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1050.00 | 1467491407 - DEARBORN SURGERY CENTER, LLC, DEARBORN SURGERY CENTER | 383494075 - (MI) DEARBORN SURGERY CENTER, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $431.00 | 1124777321 - VIRGINIA CARDIOVASCULAR SPECIALISTS, VCS HEART AND VASCULAR CENTER | 541090122 - (VA) VIRGINIA CARDIOVASCULAR SPECIALISTS PC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11406 | $1849.00 | 1235146325 - WEBSTER AMBULATORY SURGERY CENTER LP, WEBSTER SURGERY CENTER | 205953387 | MO | 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 | 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) |
| 11406 | 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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