How much does Medicare pay for CPT 11043?

Medicare allowed an average of $193.00 per service and paid $153.12 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $515.61, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11043?

Removal of muscle and/or tissue, 20.0 sq cm or less. It was billed 422,018 times to 102,800 Medicare beneficiaries by 2,164 providers in 2024.

Does 11043 pay differently in an office than a hospital?

Yes. The allowed amount averaged $220.09 in an office setting and $147.60 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 11043 most?

Family Practice, with 102,953 services from 259 clinicians. Next are General Surgery, Nurse Practitioner, Physician Assistant.

CPT 11043

Removal of muscle and/or tissue, 20.0 sq cm or less

$193.00Medicare-allowed amount per service, averaged across 422,018 services

Providers submitted

$515.61

Asking price, not received

Medicare allowed

$193.00

The fee schedule figure

Medicare paid

$153.12

Balance is patient coinsurance

Providers submitted an average of $515.61 for this code and Medicare allowed $193.00 — 2.7× 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 $153.12 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $220.09
Hospital / facility: $147.60

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. 264,325 services were billed in an office setting and 157,693 in a facility.

Services: 422,018
Beneficiaries: 102,800
Providers billing it: 2,164
Total allowed: $81,449,474

What Medicare pays for CPT 11043

Across 422,018 services billed by 2,164 providers to 102,800 beneficiaries, Medicare allowed an average of $193.00 per service. That is 4.1 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 11043

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	102,953	25,022	$197.49	259
General Surgery	75,241	17,468	$197.55	337
Nurse Practitioner	70,524	18,160	$173.72	520
Physician Assistant	45,898	8,644	$195.48	140
Podiatry	42,896	12,558	$198.22	475
Internal Medicine	19,954	4,864	$202.04	87
General Practice	16,885	3,997	$200.78	40
Plastic and Reconstructive Surgery	14,199	3,740	$187.40	82
Emergency Medicine	4,705	1,210	$202.15	36
Vascular Surgery	4,363	1,315	$179.56	46
Orthopedic Surgery	3,724	822	$192.38	17
Anesthesiology	2,626	52	$155.43	2
Obstetrics & Gynecology	2,239	677	$203.37	16
Undersea and Hyperbaric Medicine	1,731	509	$172.95	11
Physical Medicine and Rehabilitation	1,651	461	$199.34	11

11043 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	118,018	$190.27	$145.52	340
California	110,078	$208.07	$148.18	390
Texas	38,194	$189.27	$150.93	155
New York	16,663	$203.17	$140.57	109
New Jersey	11,122	$189.47	$138.19	100
Pennsylvania	9,505	$209.42	$157.08	61
Maryland	9,214	$200.09	$143.55	58
Illinois	8,769	$204.64	$153.74	68
Ohio	8,266	$175.98	$140.91	76
Massachusetts	7,523	$196.53	$145.63	52
North Carolina	6,133	$171.82	$141.91	52
Mississippi	6,092	$176.83	$150.13	55
Tennessee	6,023	$182.55	$147.53	32
Louisiana	5,480	$159.71	$133.12	52
Georgia	4,984	$178.17	$143.45	37
South Carolina	4,658	$176.02	$142.33	30
Oklahoma	4,579	$178.45	$148.21	38
Virginia	4,568	$175.44	$134.46	35
Kentucky	3,956	$167.42	$139.96	37
Arizona	3,725	$181.19	$150.15	27
Alabama	3,489	$160.94	$137.46	31
Washington	3,439	$179.31	$135.61	36
Indiana	3,416	$174.39	$138.95	27
Michigan	2,790	$164.13	$126.08	24
Connecticut	2,379	$181.78	$133.69	21
New Mexico	2,084	$184.18	$142.36	15
Colorado	2,047	$199.67	$152.71	22
Wisconsin	1,807	$181.41	$148.92	14
Oregon	1,656	$189.98	$151.99	12
Nevada	1,640	$165.59	$126.51	25
West Virginia	1,394	$193.73	$142.09	9
Minnesota	1,127	$171.85	$138.19	15
Kansas	848	$136.54	$112.78	14
Utah	787	$176.12	$140.23	12
District of Columbia	745	$194.48	$141.00	13
Arkansas	741	$127.98	$110.02	12
Missouri	680	$149.39	$119.63	13
Nebraska	536	$151.31	$133.22	6
Iowa	485	$186.56	$150.16	4
Rhode Island	445	$204.33	$152.98	6
Montana	406	$158.52	$127.98	8
Northern Mariana Islands	363	$181.95	$153.15	1
Delaware	353	$226.78	$170.56	5
Maine	264	$140.01	$113.96	2
South Dakota	190	$156.95	$129.93	4
New Hampshire	138	$196.43	$154.76	3
North Dakota	94	$174.26	$137.27	3
Hawaii	86	$200.21	$154.13	2
Idaho	39	$177.04	$151.65	1

Related codes

11042Removal of skin and tissue$84.31
11056Removal of noncancer thickened skin growth$79.85
11055Removal of noncancer thickened skin growth$66.64
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.