CPT 11640 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 • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
National average reimbursement for CPT 11640 by major payers:
$215.40
$249.72
$254.68
$327.47
| 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 11640 | ||||||
United | 11640 | $671.00 | 1255991238 - LEE SUMMIT ASC KC LLC, BEACON SURGERY CENTER | 831077983 - (MO) LEE SUMMIT ASC KC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $500.00 | 1801228481 - CENTER FOR SPINE INTERVENTIONS ASC 1 LLC | 462221027 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $2307.00 | 1245287697 - EAGLE HIGHLANDS SURGERY CENTER LLC, EAGLE HIGHLANDS SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $256.00 | 1679737043 - FRIENDSHIP SURGERY CENTER | 261779956 - (GA) FRIENDSHIP SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $1651.00 | 1780935528 - QUEENS ENDOSCOPY ASC, LLC | 274189294 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $1531.00 | 1528438884 - MCLEAN AMBULATORY SURGERY, LLC | 474966649 - (VA) MCLEAN AMBULATORY SURGERY LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $659.00 | 1104990050 - FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | 911798298 - (NM) FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $387.00 | 1770645905 - SILVER SPRING MD ENDOSCOPY ASC LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND | 205988845 - (MD) SILVER SPRING MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $967.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $520.00 | 1982975959 - ARCHIBALD SURGERY CENTER, LLC | 453730425 - (CA) ARCHIBALD SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $935.00 | 1154440972 - SEBASTOPOL ASC, L.P. | 621560936 - (CA) SEBASTOPOL ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $574.00 | 1013471754 - ADVANCED SURGERY CENTER OF LANCASTER, LLC | 831133719 - (PA) ADVANCED SURGERY CENTER OF LANCASTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $266.00 | 1255390670 - CARROLL COUNTY EYE SURGERY CENTER, LLC | 50576667 - (MD) CARROLL COUNTY EYE SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $360.00 | 1811378375 - ALEXANDRIA AMBULATORY SURGERY CENTER LP, ALEXANDRIA HEART & VASCULAR SURGERY CENTER | 471533012 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11640 | $487.00 | 1194790808 - DIGESTIVE ENDOSCOPY CENTER LLC | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | 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 11640 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11640 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 11640 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 |
|---|---|---|
| 11441-CPT | Low | Excision, Other Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Excised Diameter 0.6 To 1.0 Cm |
| 11442-CPT | Moderate | Excision, Other Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Excised Diameter 1.1 To 2.0 Cm |
| 11443-CPT | Moderate | Excision, Other Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Excised Diameter 2.1 To 3.0 Cm |
| 11640-CPT | Moderate | Excision Malignant Lesion Including Margins Face Ears Eyelids Nose Lips; Excised Diameter 0.5 Cm Or Less (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 11640. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11640 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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