CPT 11952 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 11952 by major payers:
$165.52
$180.68
$183.89
$231.85
| 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 11952 | ||||||
United | 11952 | $235.00 | 1851356786 - WAUSAU SURGERY CENTER LLC | 621525773 - (WI) WAUSAU SURGERY CENTER, L.P. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $200.00 | 1962050492 - PRECISION AMBULATORY SURGERY CENTER, LLC | 830978495 - (TX) PRECISION AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $106.47 | 1588238703 - MICHAEL WARD | 350593390 - DEACONESS HOSPITAL INC | AL | Certified Registered Nurse Anesthetist (367500000X) |
United | 11952 | $65.00 | 1548263619 - AZAR EYE SURGERY CENTER LLC | 522325381 - (MD) AZAR EYE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $1096.00 | 1144283649 - SKY RIDGE SURGERY CENTER LP | 223877040 - (CO) SKY RIDGE SURGERY CENTER LP | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $490.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $152.00 | 1255309803 - G S S C LTD PARTNERSHIP | 680343818 - (CA) GSSC LTD PARTNERSHIP DBA GREATER SACRAMENTO SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $458.00 | 1255397964 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $267.00 | 1033181862 - EL PASO ASC LP, ENDOSCOPY CENTER OF EL PASO | 621731682 - (TX) EL PASO ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $87.00 | 1386892230 - NORMAN ENDOSCOPY CENTER, LLC | 208716173 - (OK) NORMAN ENDOSCOPY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $74.00 | 1942793823 - STARKVILLE SURGERY CENTER LLC | 465332869 - (MS) STARKVILLE SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $574.00 | 1043303894 - DOCTORS OUTPATIENT SURGERY CENTER OF JUPITER, LLC, LASER & SURGERY CENTER OF THE PALM BEACHES | 650953183 - (FL) DRS. OUTPATIENT SURGERY CENTER OF JUPITER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $662.00 | 1417534207 - MEDICAL CITY SURGERY CENTER OF FRISCO, LLC | 822432064 - (TX) MEDICAL CITY SURGERY CENTER OF FRISCO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $203.00 | 1972055382 - ALLIANCE SURGERY PARTNERS, LLC | 901108673 - (CA) ALLIANCE SURGERY PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11952 | $140.00 | 1447212337 - PUGET SOUND GASTROENTEROLOGY, PLLC, EVERGREEN ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | 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 11952 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11952 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 11952 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 11952. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11952 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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