CPT 11954 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 79 - Unrelated procedure - postop period 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 11954 |
| Medicaid Fee Schedule | View Medicaid rates for 11954 |
National average reimbursement for CPT 11954 by major payers:
$187.30
$205.98
$204.73
$189.12
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 11954 | $406.00 | 1841325214 - AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | 208422547 - (MD) AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $150.00 | 1205998648 - REGIONAL EYE ASSOCIATES, INC, SURGICAL EYE CENTER OF MORGANTOWN | 550740986 - REGIONAL EYE ASSOCIATES, INC. | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $893.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $364.00 | 1285673186 - BERKSHIRE COSMETIC & RECONSTRUCTIVE SURGERY CENTER INC. | 43421240 - (MA) BERKSHIRE COSMETIC RECONSTRUCTIVE SURGERY CENTER INC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $1142.00 | 1396896684 - DREYER AMBULATORY SURGERY CENTER, LLC | 363890298 - (IL) DREYER AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $1033.00 | 1427012202 - OUTPATIENT SURGICAL SERVICES LTD | 752433596 - (FL) OUTPATIENT SURGICAL SERVICES LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $800.00 | 1669181822 - ALLIANCE SURGERY CENTER AT CUMMING | 881953675 - (GA) ALLIANCE SURGERY CENTER AT CUMMING | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $675.00 | 1194718056 - MARIN ENDOSCOPY CENTER, LLC, ENDOSCOPY CENTER OF MARIN | 680407706 - (CA) MARIN ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $1161.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $1817.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $349.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $269.29 | 1386601888 - NAJMUL SALMAN | 350593390 - DEACONESS HOSPITAL INC | TX | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 11954 | $500.00 | 1174670723 - GASTROINTESTINAL INSTITUTE, LLC. | 201622626 - (IL) GASTROINTESTINAL INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $410.00 | 1932856945 - UPPER VALLEY DIALYSIS ACCESS CENTER, LLC | 863328769 - (TX) UPPER VALLEY DIALYSIS ACCESS CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11954 | $326.00 | 1033734785 - CARDIOVASCULAR INSTITUTE OF THE SOUTH ASC, LLC | 850871914 - (LA) CARDIOVASCULAR INSTITUTE OF THE SOUTH ASC LLC | LA | 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 11954 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11954 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 11954 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 |
|---|---|---|
| 11952-CPT | Low | Subcutaneous Injection Of Fil, Subcutaneous Injection Of Filling Material (Eg Collagen)5.1 To 10.0 Cc Subcutaneous Injection Of Filling Material (Eg Collagen) |
| 11954-CPT | Low | Subcutaneous Injection Of Fil, Subcutaneous Injection Of Filling Material (Eg Collagen)5.1 To 10.0 Cc Subcutaneous Injection Of Filling Material (Eg Collagen) Filling Material (Eg Collagen) |
| 11960-CPT | High | Insrt Of Tissue Expander(S) For Other Than Breast Inclu Subse, Insertion Of Tissue Expander(S) For Other Than Breast Including Subse |
| 11970-CPT | Moderate | Skin Prosthesis Placement, Surgery To Place A Permanent Prosthesis (Structure) Where A Tissue Expander Has Been Used To Prepare Tissue To Accept The Prosthesis. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11954. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11954 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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