CPT 11765 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • TA - Left foot, great toe • T5 - Right foot, great toe |
| Complexity Level | Low |
National average reimbursement for CPT 11765 by major payers:
$183.08
$195.88
$202.86
$265.67
| 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 11765 | ||||||
United | 11765 | $792.00 | 1700431798 - METHODIST AMBULATORY SURGERY CENTER OF BOERNE, LLC | 823532569 - (TX) METHODIST AMBULATORY SURGERY CENTER OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $144.00 | 1598775231 - SURGERY CENTER OF COLUMBIA COUNTY, LLC, SURGERY CENTER OF COLUMBIA COUNTY | 743171980 - (GA) SURGERY CENTER OF COLUMBIA CTY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $1150.00 | 1083228365 - REFOCUS SURGERY CENTERS, LLC | 851258648 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $56.00 | 1588777130 - J J YOUNG MD, THE CATARACT CENTER OF LAWTON | 731221077 - (OK) J J YOUNG MD | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $67.00 | 1962031807 - CVP SURGERY CENTER IVY POINTE, LLC | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $4613.00 | 1326424144 - IU HEALTH EAST WASHINGTON AMBULATORY SURGERY CENTER, LLC, EAST WASHINGTON SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $245.00 | 1013403161 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $423.00 | 1750517561 - CANON CITY CO MULTI SPECIALTY ASC LLC, ARKANSAS VALLEY SURGERY CENTER | 264730485 - (CO) CANON CITY CO MULTI SPECIALTY ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $143.00 | 1841955358 - ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR, LLC | 852814304 - (MD) ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $2321.00 | 1467920389 - KU MEDWEST AMBULATORY SURGERY CENTER, LLC | 20664568 - (KS) KU MEDWEST AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $82.00 | 1093799405 - ORTHOARKANSAS SURGERY CENTER LLC | 710818555 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $325.00 | 1518149954 - NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER, LLC | 141983013 - (GA) NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $88.00 | 1629153770 - COTTMAN AMBULATORY SURGERY CENTER, WILLS SURGERY CENTER OF THE NORTHEAST | 232786584 - (PA) COTTMAN AMBULATORY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $129.00 | 1346287232 - MODESTO SURGERY CENTER | 770394007 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11765 | $351.00 | 1700807617 - ENDOSCOPY CENTER OF THE ROCKIES LLC, ENDOSCOPY CENTER OF THE ROCKIES LAFAYETTE | 841562782 - (CO) ENDOSCOPY CENTER OF THE ROCKIES LLC | CO | 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 11765 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11765 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 11765 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11765. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11765 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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