CPT 11642 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
National average reimbursement for CPT 11642 by major payers:
$293.53
$340.11
$349.35
$440.07
| 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 11642 | ||||||
United | 11642 | $180.00 | 1750568838 - VIVERE HEALTH DALLAS, LLC, VIVERE-DALLAS SURGERY CENTER | 364701304 - (TX) VIVERE HEALTH DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $967.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $846.00 | 1316189095 - CARILLON SURGERY CENTER LLC | 261116740 - (FL) CARILLON SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $425.00 | 1295288751 - PLASTIC HEAD AND NECK SURGERY INSTITUTE | 812018399 - (GA) PLASTIC HEAD AND NECK SURGERY INSTITUTE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $255.00 | 1831195379 - LARGO SURGERY LLC, WEST BAY SURGERY CENTER | 10553657 - (FL) LARGO SURGERY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $495.00 | 1477617751 - COLUMBIA SURGICAL SPECIALISTS, PS, COLUMBIA SURGERY CENTER | 910867604 - (WA) COLUMBIA SURGICAL SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $953.00 | 1932636123 - TUCSON DIGESTIVE INSTITUTE LLC, ARIZONA DIGESTIVE INSTITUTE | 821568426 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $520.00 | 1124395876 - RISSER SURGERY CENTER, LLC | 453644441 - (CA) RISSER SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $935.00 | 1740289024 - KOOTENAI OUTPATIENT SURGERY CNTR LLC, KOOTENAI OUTPATIENT SURGERY | 820523354 - (ID) KOOTENAI OUTPATIENT SURGERY | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $1158.00 | 1790885895 - UNITED MEDICAL ENDOSCOPY CENTER | 454651695 - (CA) ADVANCED ENDOSCOPY AND PAIN CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $480.00 | 1487782637 - EYEASSOCIATES SURGERY CENTER, INC | 581362384 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $1351.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 262652980 - (MO) FREEMAN SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $689.00 | 1174185649 - PISA ASC HOLDCO LLC, PAIN INSTITUTE OF SOUTHERN ARIZONA PROCEDURE CENTER | 831944129 - (AZ) PISA ASC HOLDCO LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $764.00 | 1548710775 - LINCOLN DIGESTIVE HEALTH CENTER LLC | 371833798 - (NE) LINCOLN DIGESTIVE HEALTH CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11642 | $935.00 | 1023159860 - THOUSAND OAKS SURGERY CENTER, LLC | 272867027 - (CA) THOUSAND OAKS SURGERY CENTER LLC | CA | 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 11642 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11642 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 11642 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 |
|---|---|---|
| 11443 | 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 |
| 11444 | Moderate | Excision, Other Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Face, Ears, Eyelids, Nose, Lips, Mucous Membrane; Excised Diameter 3.1 To 4.0 Cm |
| 11641 | Moderate | Excision Malignant Lesion Including Margins Face Ears Eyelids Nose Lips; Excised Diameter 0.6 Cm To 1.0 Cm (Desc Rev 1/1/03) |
| 11642 | Moderate | Excision Malignant Lesion Including Margins Face Ears Eyelids Nose Lips; 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 11642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11642 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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