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CPT 12011 Fee Schedule

Last Verified: January 2026

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.

Simp Rpr Face Ear Etc To 2.5 Cm
Key FactDetail
Service Type

Surgery

Surgical Procedures on the Integumentary System

Common Place of Service

23 - Emergency Room

20 - Urgent Care Facility

Common Modifiers

None

AG - Primary physician

UA

Complexity LevelLow

National average reimbursement for CPT 12011 by major payers:

bcbs

$140.76

uhc

$154.39

aetna

$159.98

cigna

$188.66

Preview provider-level rates for...
For billing codeCPT 12011
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 12011

United
12011$119.001134427297 - SURGERY CENTER OF ZACHARY, LLC811928790 - (LA) SURGERY CENTER OF ZACHARY, LLCLAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12011$857.001467574202 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA HEALTH CARE CENTER720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANALACritical Access Hospital (282NC0060X)
United
12011$1400.001902047376 - FLOWER MOUND HOSPITAL PARTNERS, LLC, TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND260684968 - (TX) FLOWER MOUND HOSPITAL PARTNERS, LLC DBA TEXAS HEALTH PRESBYTERIAN HOSPTXGeneral Acute Care Hospital (282N00000X)
United
12011$99.581407191984 - BSA HOSPITAL LLC900914340TXGeneral Acute Care Hospital (282N00000X)
United
12011$1085.001104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORDTXGeneral Acute Care Hospital (282N00000X)
United
12011$551.001417465824 - ATHENS HOSPITAL, LLC823934511TXGeneral Acute Care Hospital (282N00000X)
United
12011$149.251407191984 - BSA HOSPITAL LLC300754305TXGeneral Acute Care Hospital (282N00000X)
United
12011$2866.001265568638 - SCOTT & WHITE HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - ROUND ROCK203749695 - (TX) SCOTT & WHITE HOSPITAL ROUND ROCKTXGeneral Acute Care Hospital (282N00000X)
United
12011$104.161629369210 - SPINE INSTITUTE OF LOUISIANA LLC, SPINE INSTITUTE OF LOUISIANA320353742 - (LA) SPINE INSTITUTE OF LOUISIANA, LLCLAOrthopaedic Surgery of the Spine Physician (207XS0117X)
United
12011$265.631487815445 - CHRISTOPHER SUGALSKI720276883LAOrthopaedic Surgery Physician (207X00000X)
United
12011$551.001912060526 - EAST TEXAS MEDICAL CENTER TRINITY, COMMUNITY HEALTH CLINIC824037220TXGeneral Acute Care Hospital (282N00000X)
United
12011$1240.001619115383 - ASCENSION SETON, ASCENSION SETON HAYS741109643 - ASCENSION SETONTXGeneral Acute Care Hospital (282N00000X)
United
12011$1240.001124137054 - ASCENSION SETON, ASCENSION SETON NORTHWEST741109643 - ASCENSION SETONTXGeneral Acute Care Hospital (282N00000X)
United
12011$318.001003925959 - HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA., HOOD MEMORIAL HOSPITAL720694946 - (LA) HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LALACritical Access Hospital (282NC0060X)
United
12011$182.631720004864 - CRAIG GREENE721460193 - (LA) BATON ROUGE ORTHOPAEDIC CLINIC, LLCLAOrthopaedic Surgery Physician (207X00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 12011 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 12011 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 12011 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.

CodeComplexityDescription
12011-CPTLowSimp Rpr Face Ear Etc To 2.5 Cm
12013-CPTLowRep Simple Face Adnexa 2.5-5 Cm
12014-CPTLowSimp Rpr Face Ear Etc 5.1-7.5 Cm
12020-CPTModerateClosure Superfic Wound Dehiscence

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 12011 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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