CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

Medicare pays $247 and commercial payers pay $430 on average nationally for this procedure.

CPT code 11043 describes surgical debridement using instruments to remove necrotic tissue that includes muscle and/or fascia and may include epidermis, dermis, and subcutaneous tissue for the first or only 20 cm2 or less; the service is a surgical wound debridement procedure typically performed in an operating room or procedure suite (ambulatory surgery center or hospital) under appropriate anesthesia and sterile technique.

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National Reimbursement Benchmarks

Medicare’s mean of $246.5 sits below BUCA’s average commercial mean of $429.9, indicating that average commercial reimbursements in BUCA are roughly $183.4 higher than Medicare for CPT 11043. This gap highlights that commercial networks tend to pay materially more than Medicare for this procedure, with BUCA representing a strong commercial midpoint compared with other national carriers.

Dispersion varies meaningfully across payers: Blue Cross Blue Shield has the widest interquartile spread ($648.5 - $414.2 = $234.3), followed by UnitedHealth Group ($430.4 - $223.5 = $206.9). Aetna’s spread is narrower ($226.3 - $67 = $159.3), and Cigna sits between those ($391.4 - $206.6 = $184.8). BUCA’s IQR is $520.3 - $307.7 = $212.6. Medicare’s interquartile span is tight at $256 - $232 = $24, reflecting much lower variability across localities.

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CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

Medicare pays $247 and commercial payers pay $430 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 11043 policy alerts

Get alerted when payer policies referencing 11043 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with long-standing Type 2 diabetes mellitus presents to the hospital with a chronic right thigh wound that has become increasingly necrotic and malodorous despite outpatient wound care. The referring clinician documents worsening peripheral arterial disease and a surrounding area of nonviable muscle and fascia on exam. Vascular assessment demonstrates decreased distal pulses and the diagnosis of E11.52 (diabetic peripheral angiopathy with gangrene) or I70.231 (atherosclerosis of native arteries of right leg with ulceration of thigh) is recorded. The surgical team schedules operative sharp debridement under appropriate anesthesia in the operating room.

The clinical workflow includes preoperative evaluation (medical optimization, consent, and vascular assessment), intraoperative documentation of wound size and depth (confirming removal of muscle and/or fascia with total debrided area 20 cm2 or less), specimen handling if indicated, and immediate postoperative wound care planning with orders for dressings, antibiotics if infected, and follow-up wound clinic or vascular surgery. Documentation must support extent of tissue removed, anatomic site, anesthesia, and any complications or concurrent procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (includes epidermis and dermis, if performed)	Lower-depth debridement option when muscle or fascia are not involved; choose `11042` if only subcutaneous tissue is removed instead of muscle/fascia.
`11044`	Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed)	Use when debridement extends to bone; represents a more extensive procedure than `11043`.
`97597`	Debridement, open wound, selective debridement, without anesthesia (first 20 sq cm or less)	Non-surgical selective debridement option (often in clinic) that can be an alternative to surgical sharp debridement coded with `11043`.
`97598`	Each additional 20 sq cm, or part thereof	Adjunct code to `97597` for larger wounds; not used with `11043` which is limited to first 20 cm2 or less.
`11010`	Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s)	Related when debridement is associated with open fractures; distinct clinical scenario from diabetic/vascular ulcer debridement.
`11012`	Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s)	Similar to `11010`, used for more extensive or different anatomic contexts related to traumatic wounds.

Related Modifiers

8 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
24	Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…	- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207XS0117X	Orthopaedic Surgery of the Spine Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
261QX0203X	Radiation Oncology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QM1000X	Migrant Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RS0012X	Sleep Medicine (Internal Medicine) Physician	An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic t…
2081P0004X	Spinal Cord Injury Medicine Physician	A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal c…
103TA0700X	Adult Development & Aging Psychologist	A psychologist who specializes in geropsychology, which applies the knowledge and methods of psychology to understanding and helping older persons and…

CPT 11000: Surgical Debridement of Skin, Up to 10% BSA

CPT-11001-ADD-ON-SURGICAL-DEBRIDEMENT-UP-TO-10-PERCENT

CPT 11001: Surgical Debridement, Add-on, Additional Up to 10% Skin

CPT-11004-PERINEAL-GENITAL-NECROTIC-TISSUE-DEBRIDEMENT

CPT 11004: Debridement of External Genitalia and Perineum

CPT-11005-ABDOMINAL-WALL-DEBRIDEMENT-NECROTIC-TISSUE-EVALUATION

CPT 11005: Abdominal Wall Debridement of Necrotic Tissue

CPT-11006-NECROTIZING-SOFT-TISSUE-DEBRIDEMENT-GENITALIA-PERINEUM

CPT 11006: Debridement of Necrotic Tissue, Genitalia/Perineum/Abdominal Wall

CPT-11008-ABDOMINAL-WALL-PROSTHETIC-MESH-REMOVAL-INFECTION

CPT 11008: Removal of Prosthetic Material or Mesh from Abdominal Wall

CPT-11010-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION

CPT 11010: Debridement for Open Fracture or Dislocation

CPT-11011-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION-DEEP-TISSUES

CPT 11011: Debridement for Open Fracture or Dislocation

CPT-11012-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION-DEEP-TISSUE

CPT 11012: Debridement for Open Fracture Wound

CPT-11042-SURGICAL-DEBRIDEMENT-SKIN-SUBCUTANEOUS

CPT 11042: Surgical Debridement of Skin and Subcutaneous Tissue, Up to 20 cm2

Showing 1–10 of 14

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (includes epidermis and dermis, if performed)	Lower-depth debridement option when muscle or fascia are not involved; choose `11042` if only subcutaneous tissue is removed instead of muscle/fascia.
`11044`	Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed)	Use when debridement extends to bone; represents a more extensive procedure than `11043`.
`97597`	Debridement, open wound, selective debridement, without anesthesia (first 20 sq cm or less)	Non-surgical selective debridement option (often in clinic) that can be an alternative to surgical sharp debridement coded with `11043`.
`97598`	Each additional 20 sq cm, or part thereof	Adjunct code to `97597` for larger wounds; not used with `11043` which is limited to first 20 cm2 or less.
`11010`	Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s)	Related when debridement is associated with open fractures; distinct clinical scenario from diabetic/vascular ulcer debridement.
`11012`	Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s)	Similar to `11010`, used for more extensive or different anatomic contexts related to traumatic wounds.

Related Modifiers

8 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
24	Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…	- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207XS0117X	Orthopaedic Surgery of the Spine Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with th…
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
261QX0203X	Radiation Oncology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QM1000X	Migrant Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207RS0012X	Sleep Medicine (Internal Medicine) Physician	An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic t…
2081P0004X	Spinal Cord Injury Medicine Physician	A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal c…
103TA0700X	Adult Development & Aging Psychologist	A psychologist who specializes in geropsychology, which applies the knowledge and methods of psychology to understanding and helping older persons and…

CPT 11000: Surgical Debridement of Skin, Up to 10% BSA

CPT-11001-ADD-ON-SURGICAL-DEBRIDEMENT-UP-TO-10-PERCENT

CPT 11001: Surgical Debridement, Add-on, Additional Up to 10% Skin

CPT-11004-PERINEAL-GENITAL-NECROTIC-TISSUE-DEBRIDEMENT

CPT 11004: Debridement of External Genitalia and Perineum

CPT-11005-ABDOMINAL-WALL-DEBRIDEMENT-NECROTIC-TISSUE-EVALUATION

CPT 11005: Abdominal Wall Debridement of Necrotic Tissue

CPT-11006-NECROTIZING-SOFT-TISSUE-DEBRIDEMENT-GENITALIA-PERINEUM

CPT 11006: Debridement of Necrotic Tissue, Genitalia/Perineum/Abdominal Wall

CPT-11008-ABDOMINAL-WALL-PROSTHETIC-MESH-REMOVAL-INFECTION

CPT 11008: Removal of Prosthetic Material or Mesh from Abdominal Wall

CPT-11010-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION

CPT 11010: Debridement for Open Fracture or Dislocation

CPT-11011-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION-DEEP-TISSUES

CPT 11011: Debridement for Open Fracture or Dislocation

CPT-11012-DEBRIDEMENT-OPEN-FRACTURE-DISLOCATION-DEEP-TISSUE

CPT 11012: Debridement for Open Fracture Wound

CPT-11042-SURGICAL-DEBRIDEMENT-SKIN-SUBCUTANEOUS

CPT 11042: Surgical Debridement of Skin and Subcutaneous Tissue, Up to 20 cm2

Showing 1–10 of 14

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

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National Reimbursement Benchmarks

OpenPayer

CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

Sign up for cpt 11043 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

Sign up for cpt 11043 policy alerts

National Reimbursement Benchmarks

CPT 11043: Surgical Debridement of Muscle and/or Fascia, ≤20 cm2

Sign up for cpt 11043 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 11043 represent and where is it typically performed?

What documentation elements are required to support billing for CPT 11043?

How do I choose between CPT 11043 and related CPT codes like 11042 or 11044?

Which diagnosis codes in the page content are relevant to support medical necessity for CPT 11043?

What other CPT codes are listed as alternatives or related procedures to CPT 11043?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 11043 represent and where is it typically performed?

What documentation elements are required to support billing for CPT 11043?

How do I choose between CPT 11043 and related CPT codes like 11042 or 11044?

Which diagnosis codes in the page content are relevant to support medical necessity for CPT 11043?

What other CPT codes are listed as alternatives or related procedures to CPT 11043?

References