CPT 12011 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 | • 23 - Emergency Room • 20 - Urgent Care Facility |
| Common Modifiers | • None • AG - Primary physician • UA |
| Complexity Level | Moderate |
National average reimbursement for CPT 12011 by major payers:
$140.76
$154.39
$159.98
$188.66
| 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 12011 | ||||||
United | 12011 | $68.00 | 1306079330 - WHITEWATER SURGERY CENTER LLC, WHITEWATER SURGERY CENTER | 264540954 - (IN) WHITEWATER SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $175.00 | 1730463753 - PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PERIMETER | 201285759 - (GA) PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PERIMETER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $211.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $87.00 | 1164469086 - SAME DAY SURGICARE OF NEW ENGLAND, INC., SAME DAY SURGICLINIC | 42808359 - (MA) SAME DAY SURGICARE OF NEW ENGLAND, INC. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $464.00 | 1275532889 - COAST SURGERY CENTER L P, COAST SURGERY CENTER OF SOUTH BAY | 450463066 - (CA) COAST SURGERY CENTER L P | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $464.00 | 1093771073 - ARTEL LLC | 263513966 - (CA) ARTEL, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $464.00 | 1417534207 - MEDICAL CITY SURGERY CENTER OF FRISCO, LLC | 822432064 - (TX) MEDICAL CITY SURGERY CENTER OF FRISCO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $119.00 | 1134427297 - SURGERY CENTER OF ZACHARY, LLC | 811928790 - (LA) SURGERY CENTER OF ZACHARY, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12011 | $104.16 | 1629369210 - SPINE INSTITUTE OF LOUISIANA LLC, SPINE INSTITUTE OF LOUISIANA | 320353742 - (LA) SPINE INSTITUTE OF LOUISIANA, LLC | LA | Orthopaedic Surgery of the Spine Physician (207XS0117X) |
United | 12011 | $1472.00 | 1376071530 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., LLP, METHODIST HOSPITAL ATASCOSA | 742730328 | TX | General Acute Care Hospital (282N00000X) |
United | 12011 | $206.25 | 1548230048 - PETER VIZZI | 200736590 - (LA) PETER D VIZZI MD AMC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 12011 | $102.30 | 1821421389 - LELAND MCCLUSKEY | 720898076 - (LA) L THOMAS CASHIO MD MARK JUNEAU JR MDPC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 12011 | $570.00 | 1821087164 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 12011 | $2866.00 | 1144781501 - BAYLOR SCOTT & WHITE MEDICAL CENTERS, BAYLOR SCOTT & WHITE MEDICAL CENTER - BUDA | 813040663 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTERS-CAPITOL AREA | TX | General Acute Care Hospital (282N00000X) |
United | 12011 | $1480.00 | 1134166192 - ORTHOPEDIC HOSPITAL LTD, TEXAS ORTHOPEDIC HOSPITAL | 760418502 - (TX) ORTHOPEDIC HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
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 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.
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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