CPT 11626 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 11626 by major payers:
$434.36
$513.83
$528.45
$659.40
| 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 11626 | ||||||
United | 11626 | $1356.00 | 1699246181 - DEERBROOK ASC LLC | 823478937 - (TX) DEERBROOK ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $986.00 | 1992765986 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, WALDRON ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $2307.00 | 1891148219 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $1300.00 | 1639224827 - OAK SURGICAL INSTITUTE | 364337136 - (IL) OAK SURGICAL INSTITUTE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $742.00 | 1902863723 - OAK & MAIN SURGICENTER LLC | 223532371 - (NJ) OAK MAIN SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $935.00 | 1346868890 - UPNT SURGERY LLC | 371939831 - (TX) UPNT SURGERY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $1556.00 | 1619970472 - CYPRESS OUTPATIENT SURGICAL CENTER, INC. | 770173551 - (CA) CYPRESS OUTPATIENT SURGICAL CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $3150.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $1045.00 | 1548223654 - SPARTAN HEALTH SURGICENTER LLC | 251898641 - (PA) SPARTAN HEALTH SURGICENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $2308.00 | 1336665306 - EAGAN ORTHOPEDIC SURGERY CENTER LLC | 822364448 - (MN) EAGAN ORTHOPEDIC SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $3150.00 | 1609870336 - DESOTO SURGICARE PARTNERS, LTD, NORTH TEXAS SURGERY CENTER | 752592508 - (TX) DESOTO SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $4304.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $2859.00 | 1124498357 - ENDOSCOPY CENTER OF INLAND EMPIRE LLC | 474733900 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $1100.00 | 1508840893 - PARKWAY SURGERY CENTER | 621799370 - (SC) PARKWAY SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11626 | $1645.00 | 1871926428 - CHILDREN 1ST HOUSTON SOUTH, LLC, CHILDREN 1ST DENTAL & SURGERY CENTER | 320417239 | TX | 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 11626 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11626 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 11626 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 |
|---|---|---|
| 11620 | Moderate | Excision Malignant Lesion Including Margins Scalp Neck Hands Feet Genitalia; Excised Diameter 0.5 Cm Or Less (Desc Rev 1/1/03) |
| 11621 | Moderate | Excision Malignant Lesion Including Margins Scalp Neck Hands Feet Genitalia; Excised Diameter 0.5 Cm To 1.0 Cm (Desc Rev 1/1/03) |
| 11622 | Moderate | Excision Malignant Lesion Including Margins Scalp Neck Hands Feet Genitalia; Excised Diameter 1.1 Cm To 2.0 Cm (Desc Rev 1/1/03) |
| 11626 | Moderate | Excision Malignant Lesion Including Margins 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 11626. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11626 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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