How much does Medicare pay for CPT 11046?

Medicare allowed an average of $62.70 per service and paid $50.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $179.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11046?

Removal of muscle and/or tissue, each additional 20.0 sq cm or less. It was billed 166,461 times to 17,782 Medicare beneficiaries by 635 providers in 2024.

Does 11046 pay differently in an office than a hospital?

Yes. The allowed amount averaged $69.01 in an office setting and $54.50 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 11046 most?

Nurse Practitioner, with 35,741 services from 163 clinicians. Next are Physician Assistant, General Surgery, Family Practice.

CPT 11046

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

$62.70Medicare-allowed amount per service, averaged across 166,461 services

Providers submitted

$179.95

Asking price, not received

Medicare allowed

$62.70

The fee schedule figure

Medicare paid

$50.03

Balance is patient coinsurance

Providers submitted an average of $179.95 for this code and Medicare allowed $62.70 — 2.9× 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 $50.03 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $69.01
Hospital / facility: $54.50

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. 93,991 services were billed in an office setting and 72,470 in a facility.

Services: 166,461
Beneficiaries: 17,782
Providers billing it: 635
Total allowed: $10,437,105

What Medicare pays for CPT 11046

Across 166,461 services billed by 635 providers to 17,782 beneficiaries, Medicare allowed an average of $62.70 per service. That is 9.4 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 11046

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	35,741	4,038	$57.36	163
Physician Assistant	35,178	2,827	$61.54	72
General Surgery	29,707	3,380	$66.01	125
Family Practice	14,425	2,488	$61.72	88
Plastic and Reconstructive Surgery	11,593	1,169	$61.79	41
General Practice	8,191	996	$68.43	22
Internal Medicine	7,072	885	$69.55	34
Anesthesiology	6,696	38	$63.70	1
Podiatry	4,186	545	$58.51	31
Orthopedic Surgery	3,000	181	$68.20	6
Emergency Medicine	2,589	249	$76.22	7
Vascular Surgery	1,236	188	$59.61	11
Physical Medicine and Rehabilitation	1,205	116	$77.54	2
Undersea and Hyperbaric Medicine	1,023	118	$55.61	3
Thoracic Surgery	872	99	$66.38	4

11046 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
California	69,483	$64.75	$47.89	162
Florida	28,443	$59.38	$44.70	129
New York	14,361	$66.56	$44.90	30
Texas	5,596	$65.99	$51.54	46
New Jersey	4,536	$60.13	$44.42	34
Mississippi	4,478	$59.52	$50.43	18
Maryland	3,598	$66.23	$47.39	18
Massachusetts	3,389	$62.73	$49.65	8
Louisiana	2,882	$49.18	$40.63	18
Georgia	2,744	$62.75	$49.70	7
Pennsylvania	2,587	$67.29	$51.46	9
Illinois	2,517	$72.29	$52.32	20
Oregon	2,165	$65.71	$54.35	3
Oklahoma	2,088	$52.23	$44.00	12
Arizona	2,003	$67.27	$53.64	6
Virginia	1,925	$55.73	$44.78	8
Alabama	1,829	$51.94	$44.11	7
Ohio	1,522	$54.87	$43.66	13
North Carolina	1,335	$46.57	$39.53	16
Kentucky	1,271	$53.11	$41.59	5
Tennessee	1,107	$55.52	$44.51	8
New Mexico	830	$63.02	$48.02	3
District of Columbia	787	$61.61	$45.89	8
Michigan	739	$58.83	$42.26	6
Washington	685	$59.22	$45.91	5
South Carolina	685	$56.96	$46.24	5
Connecticut	626	$65.71	$49.30	5
Indiana	469	$67.28	$51.15	3
Colorado	438	$60.91	$47.88	5
West Virginia	422	$59.20	$44.44	2
Utah	246	$55.08	$43.96	1
Nevada	217	$46.27	$38.97	6
Missouri	82	$75.33	$57.13	1
Kansas	77	$45.72	$42.53	1
Montana	65	$51.89	$42.80	1
Iowa	54	$71.75	$57.03	1
Arkansas	50	$63.29	$51.86	2
Nebraska	50	$64.01	$56.91	1
Maine	41	$49.95	$42.19	1
Delaware	39	$71.29	$57.01	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
11043Removal of muscle and/or tissue$193.00
11045Removal of skin and tissue$28.86
11057Removal of noncancer thickened skin growth$87.46
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.