CPT 11426 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 11426 by major payers:
$378.84
$421.92
$436.40
$531.68
| 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 11426 | ||||||
United | 11426 | $1125.00 | 1447225503 - BAPTIST DESOTO SURGERY CENTER, LP | 200804946 - (MS) BAPTIST DESOTO SURGERY CENTER LP | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $2300.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 843362063 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1700.00 | 1295339737 - BEST CENTERS OF AMERICA-OHIO, LLC | 852707643 - (OH) BEST CENTERS OF AMERICAOHIO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $2388.00 | 1841712452 - SAINT THOMAS SURGERY CENTER NEW SALEM, LLC | 822137177 - (TN) SAINT THOMAS SURGERY CENTER NEW SALEM LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $2388.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1514.00 | 1912174996 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $2044.00 | 1881659613 - WEST HILLS SURGICAL CENTER LTD | 621625014 - (CA) WEST HILLS SURGICAL CENTER LTD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1682.00 | 1124086608 - LUTHERAN CAMPUS ASC LLC, THE SURGERY CENTER AT LUTHERAN | 20749532 - (CO) LUTHERAN CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1422.00 | 1255607628 - MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, PC, ALLSPINE SURGERY CENTER | 274395849 - (GA) MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $951.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $937.00 | 1700881539 - ARTURO BETANCOURT, M.D., P.A., BALTIMORE WASHINGTON EYE CENTER | 522032553 - (MD) ARTURO BETANCOURT, MD, PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1906.00 | 1588711162 - SEATTLE HAND SURGERY GROUP PC, SEATTLE HAND SURGERY UNIT, INC | 911652268 - (WA) SEATTLE HAND SURGERY GROUP, P.C. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1030.00 | 1821372467 - THE EYE SURGICENTER OF NEW JERSEY, LLC | 453067378 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $640.00 | 1508862160 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 465002052 - (OK) TRIAD EYE INSTITUTE, PLLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11426 | $1656.00 | 1568445062 - EYE SURGERY & LASER CENTER OF WISCONSIN LLC | 461222222 | WI | 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 11426 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11426 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 11426 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 |
| 11420 | 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) |
| 11426 | Moderate | Excision Benign Lesion Including Margins Except Skin Tag (Unless Listed Elsewhere) Scalp Neck Hands Feet Genitalia; 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 11426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11426 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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