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    OpenPayerBilling CodesDebridement Procedures on the SkinCPT cpt-11043-surgical-debridement-muscle-fascia-20cm2-or-less
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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.

    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.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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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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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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 CodeDescriptionRelationship to This Procedure

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT 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.,…
    59Modifier 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…
    52Modifier ‑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…
    53Modifier 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…
    76Modifier -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…
    77Modifier 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…
    22Modifier –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…
    24Modifier 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
    207XS0117X
    208600000X
    207P00000X
    261QX0203X
    261QM1000X
    207RS0012X
    2081P0004X
    103TA0700X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-11000-SURGICAL-DEBRIDEMENT-SKIN-UP-TO-10-PERCENT-BODY-SURFACE

    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. 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. 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. 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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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    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.
    11044Debridement, 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.
    97597Debridement, 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.
    97598Each additional 20 sq cm, or part thereofAdjunct code to 97597 for larger wounds; not used with 11043 which is limited to first 20 cm2 or less.
    11010Debridement 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.
    11012Debridement 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.