How much does Medicare pay for CPT 11042?

Medicare allowed an average of $84.31 per service and paid $65.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $274.30, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11042?

Removal of skin and tissue, 20.0 sq cm or less. It was billed 1,868,578 times to 512,766 Medicare beneficiaries by 11,297 providers in 2024.

Does 11042 pay differently in an office than a hospital?

Yes. The allowed amount averaged $109.43 in an office setting and $54.39 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 11042 most?

Podiatry, with 554,047 services from 4,988 clinicians. Next are Nurse Practitioner, Family Practice, General Surgery.

CPT 11042

Removal of skin and tissue, 20.0 sq cm or less

$84.31Medicare-allowed amount per service, averaged across 1,868,578 services

Providers submitted

$274.30

Asking price, not received

Medicare allowed

$84.31

The fee schedule figure

Medicare paid

$65.59

Balance is patient coinsurance

Providers submitted an average of $274.30 for this code and Medicare allowed $84.31 — 3.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $65.59 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $109.43
Hospital / facility: $54.39

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,015,567 services were billed in an office setting and 853,011 in a facility.

Services: 1,868,578
Beneficiaries: 512,766
Providers billing it: 11,297
Total allowed: $157,539,811

What Medicare pays for CPT 11042

Across 1,868,578 services billed by 11,297 providers to 512,766 beneficiaries, Medicare allowed an average of $84.31 per service. That is 3.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 11042

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	554,047	149,133	$104.13	4,988
Nurse Practitioner	487,402	137,330	$73.32	2,695
Family Practice	198,658	55,245	$80.40	620
General Surgery	190,312	51,001	$77.08	855
Physician Assistant	105,464	31,067	$81.80	519
Internal Medicine	83,011	20,536	$79.41	319
Emergency Medicine	56,447	15,595	$62.10	239
Vascular Surgery	29,272	8,095	$71.54	238
Plastic and Reconstructive Surgery	23,431	7,187	$74.13	172
General Practice	23,377	6,582	$88.45	78
Infectious Disease	20,175	5,209	$71.38	118
Undersea and Hyperbaric Medicine	16,875	4,335	$78.54	60
Physical Medicine and Rehabilitation	10,896	2,811	$61.20	43
Orthopedic Surgery	8,971	2,629	$75.19	60
Obstetrics & Gynecology	5,901	1,815	$76.92	28

11042 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	257,616	$85.28	$65.77	1,067
California	237,112	$101.75	$71.09	1,082
Texas	160,159	$86.61	$69.11	846
Ohio	74,776	$74.05	$59.88	559
New Jersey	74,346	$93.32	$67.10	470
New York	73,925	$93.68	$66.54	529
Illinois	73,856	$87.33	$66.39	486
Pennsylvania	52,819	$85.24	$66.51	458
Massachusetts	52,183	$80.40	$58.65	258
Indiana	50,264	$72.16	$60.20	311
North Carolina	49,936	$69.95	$57.44	350
Maryland	42,135	$90.40	$66.68	244
Tennessee	41,982	$75.64	$63.81	277
Virginia	41,650	$83.58	$64.24	287
Mississippi	37,082	$77.98	$67.20	159
Michigan	35,461	$81.33	$63.94	357
Louisiana	34,929	$79.92	$67.60	218
Missouri	33,218	$78.56	$64.14	196
Georgia	32,508	$84.59	$68.00	260
Arizona	32,194	$84.50	$66.85	254
Oklahoma	29,447	$72.78	$61.36	167
Kentucky	28,806	$72.09	$59.80	191
South Carolina	27,528	$73.37	$60.09	186
Washington	26,927	$82.77	$62.43	169
Arkansas	21,588	$66.86	$58.17	117
Nevada	21,466	$81.54	$64.85	130
Kansas	20,962	$74.02	$63.21	99
Connecticut	19,977	$81.94	$59.12	138
Alabama	19,589	$63.57	$54.28	137
Colorado	16,740	$84.42	$64.05	140
Iowa	16,718	$67.53	$55.95	109
Utah	15,510	$84.41	$68.51	131
Wisconsin	14,449	$73.81	$59.66	133
Minnesota	11,546	$74.41	$58.05	114
Oregon	9,198	$88.09	$68.13	94
Idaho	8,115	$72.97	$61.55	60
Montana	8,114	$66.51	$50.78	48
West Virginia	8,007	$69.40	$55.42	59
Nebraska	8,005	$66.53	$56.00	70
New Mexico	7,638	$96.69	$77.50	72
Hawaii	6,102	$89.46	$66.68	28
New Hampshire	5,875	$75.97	$58.51	35
Rhode Island	5,821	$83.76	$63.99	42
Delaware	5,285	$78.24	$61.63	33
South Dakota	4,020	$57.82	$46.43	28
Maine	2,883	$72.62	$55.33	24
North Dakota	2,795	$64.63	$51.11	25
District of Columbia	2,775	$90.54	$63.61	19
Alaska	1,347	$74.53	$45.90	8
Vermont	727	$87.79	$69.12	11
Northern Mariana Islands	713	$80.40	$67.69	1
Wyoming	669	$96.36	$72.19	4
Guam	521	$87.78	$64.78	3
AE	366	$79.83	$59.59	1
Puerto Rico	106	$89.86	$74.72	2
XX	92	$102.56	$81.68	1

Related codes

11056Removal of noncancer thickened skin growth$79.85
11055Removal of noncancer thickened skin growth$66.64
11043Removal of muscle and/or tissue$193.00
11045Removal of skin and tissue$28.86
11057Removal of noncancer thickened skin growth$87.46
11046Removal of muscle and/or tissue$62.70
11044Removal of bone$273.61
11047Removal of bone$109.02
11000Removal of inflamed or infected skin$50.90

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.