CPT 11422 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 | Low |
National average reimbursement for CPT 11422 by major payers:
$193.68
$222.67
$234.54
$291.22
| 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 11422 | ||||||
United | 11422 | $208.38 | 1639256266 - IMPERIAL HEALTH LLP | 721005645 - (LA) IMPERIAL HEALTH, LLP | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11422 | $223.00 | 1700854288 - LAMB HEALTHCARE CENTER | 752388515 - (TX) LAMB HEALTHCARE CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 11422 | $1370.00 | 1821087164 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 11422 | $849.00 | 1669705034 - EYE SPECIALISTS SURGERY CENTERS, LLC, MUNCIE SURGICAL CARE CENTER | 270927202 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $344.00 | 1760598577 - ACUTE & CHRONIC PAIN MANAGEMENT CENTER PA, ACUTE & CHRONIC PAIN AND SPINE CENTER | 752711926 - (TX) ACUTE AND CHRONIC PAIN AND SPINE CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $501.00 | 1972581940 - THE COMMUNITY HOSPITAL OF BRAZOSPORT, BRAZOSPORT MEMORIAL HOSPITAL &BRAZOSPORT REGIONAL HEALTH SYSTEM | 741385192 - (TX) COMMUNITY HOSPITAL OF BRAZOSPORT | TX | General Acute Care Hospital (282N00000X) |
United | 11422 | $799.00 | 1982672283 - ROSEVILLE SURGERY CENTER, LP, ROSEVILLE SURGERY CENTER | 202468557 - (CA) ROSEVILLE SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $325.00 | 1689624793 - SURGERY CENTER OF SOUTHWEST FLORIDA INC | 843798404 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $934.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $293.32 | 1407804107 - NIELS LINSCHOTEN | 721460193 - (LA) BATON ROUGE ORTHOPAEDIC CLINIC, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 11422 | $413.00 | 1376852855 - PAIN MANAGEMENT PROFESSIONALS OF BAYTOWN PLLC, ADVANCED PAIN MANAGEMENT SPECIALISTS OF BAYTOWN | 263216787 - PAIN MANAGEMENT PROFESSIONALS OF BAYTOWN PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $583.00 | 1891717823 - AMBULATORY SURGICAL CENTER, LLC | 391993406 - (WI) AMBULATORY SURGICAL CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $600.00 | 1255846762 - APEX AMBULATORY SURGERY CENTER INC | 820823327 - (CA) APEX AMBULATORY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $318.00 | 1104214261 - WEST CENTRAL SURGICAL CENTER-BAYSIDE | 472619181 - (OH) WEST CENTRAL SURGICAL CENTERBAYSIDE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11422 | $700.00 | 1336562156 - RYE SURGICAL CENTER, LLC | 463464240 - (NH) RYE SURGICAL CENTER LLC | NH | 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 11422 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11422 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 11422 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 |
| 11420-CPT | Low | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Scalp Neck Hands Feet Genitalia; Excised Diameter 0.5 Cm Or Less (Desc Rev 1/1/03) |
| 11422-CPT | Low | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Scalp Neck Hands Feet Genitalia; Excised Diameter 1.1 Cm To 2.0 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 11422. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11422 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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