How much does Medicare pay for CPT 11055?

Medicare allowed an average of $66.64 per service and paid $48.95 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $112.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11055?

Removal of noncancer thickened skin growth, 1 growth. It was billed 734,657 times to 392,329 Medicare beneficiaries by 6,779 providers in 2024.

Does 11055 pay differently in an office than a hospital?

Yes. The allowed amount averaged $68.99 in an office setting and $15.02 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 11055 most?

Podiatry, with 718,390 services from 6,562 clinicians. Next are Nurse Practitioner, Physician Assistant, Internal Medicine.

CPT 11055

Removal of noncancer thickened skin growth, 1 growth

$66.64Medicare-allowed amount per service, averaged across 734,657 services

Providers submitted

$112.80

Asking price, not received

Medicare allowed

$66.64

The fee schedule figure

Medicare paid

$48.95

Balance is patient coinsurance

Providers submitted an average of $112.80 for this code and Medicare allowed $66.64 — 1.7× 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 $48.95 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $68.99
Hospital / facility: $15.02

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. 702,669 services were billed in an office setting and 31,988 in a facility.

Services: 734,657
Beneficiaries: 392,329
Providers billing it: 6,779
Total allowed: $48,957,542

What Medicare pays for CPT 11055

Across 734,657 services billed by 6,779 providers to 392,329 beneficiaries, Medicare allowed an average of $66.64 per service. That is 1.9 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 11055

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	718,390	380,890	$67.01	6,562
Nurse Practitioner	10,840	8,093	$51.54	143
Physician Assistant	3,420	2,329	$54.28	36
Internal Medicine	641	163	$38.58	2
Orthopedic Surgery	436	300	$63.31	15
General Surgery	316	222	$31.76	4
General Practice	207	57	$12.35	2
Family Practice	147	78	$23.22	5
Emergency Medicine	67	48	$12.20	2
Certified Clinical Nurse Specialist	47	25	$54.83	2
Dermatology	39	37	$57.25	2
Vascular Surgery	34	28	$38.40	1
Unknown Supplier/Provider Specialty	34	29	$33.63	1
Infectious Disease	20	12	$64.79	1
Sports Medicine	19	18	$15.05	1

11055 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	108,738	$69.97	$46.52	863
Pennsylvania	78,320	$65.82	$49.82	564
New York	57,375	$72.43	$50.46	469
Florida	48,016	$62.10	$47.61	368
Illinois	47,144	$63.87	$48.16	306
New Jersey	42,438	$74.67	$51.40	381
Maryland	29,677	$72.45	$50.57	210
Massachusetts	27,904	$73.09	$50.49	177
Texas	24,637	$63.49	$49.31	285
Ohio	21,227	$62.47	$48.75	302
Arizona	19,310	$66.93	$49.75	209
Michigan	18,391	$64.92	$50.09	214
Missouri	14,454	$59.98	$47.07	136
Washington	12,428	$64.13	$43.93	157
Virginia	12,098	$66.15	$48.44	153
North Carolina	12,071	$62.39	$50.01	160
Connecticut	11,694	$73.75	$51.41	95
Indiana	11,274	$59.40	$47.58	126
Wisconsin	9,758	$63.75	$47.97	95
Oregon	9,109	$66.17	$48.07	97
Georgia	8,817	$64.69	$49.87	156
Iowa	8,658	$59.08	$45.64	89
Minnesota	7,923	$67.12	$47.51	75
Nevada	7,367	$61.41	$46.90	47
Kentucky	7,346	$59.91	$50.17	84
Rhode Island	7,198	$70.16	$48.44	53
South Carolina	7,002	$63.79	$49.45	83
Utah	6,768	$63.92	$48.88	87
Tennessee	6,264	$60.27	$49.48	108
Kansas	6,248	$57.04	$46.17	56
Delaware	5,681	$67.63	$49.55	44
Colorado	5,050	$66.13	$46.86	62
Oklahoma	3,447	$59.02	$51.04	41
Montana	3,239	$61.60	$43.76	35
Nebraska	3,152	$53.42	$44.31	38
Alabama	2,984	$61.08	$50.67	45
Idaho	2,749	$56.75	$43.97	39
Louisiana	2,735	$46.17	$38.32	41
Maine	1,988	$69.52	$48.24	17
West Virginia	1,881	$57.87	$46.58	28
South Dakota	1,861	$40.54	$29.07	22
New Mexico	1,788	$62.57	$48.13	37
New Hampshire	1,490	$67.43	$48.61	17
Arkansas	1,395	$59.98	$50.11	25
North Dakota	1,193	$38.37	$28.27	24
Mississippi	1,071	$59.01	$50.38	14
District of Columbia	875	$78.95	$51.58	11
Hawaii	771	$72.46	$51.41	11
Vermont	529	$58.15	$41.61	8
Wyoming	524	$68.91	$47.75	6
XX	335	$70.74	$53.79	1
Alaska	265	$56.72	$36.83	8

Related codes

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