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CPT code 11004: Infection debridement, external genitalia and perineum2026 Medicare rate & RVUs

Reports operative removal of infected, nonviable tissue from the external genitalia and perineum for necrotizing soft-tissue infection, such as Fournier gangrene.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.1K Medicare services in 2024

Medicare pays $504.69 for 11004 nationally in a facility.

Medicare rate · 11004

Infection debridement, external genitalia and perineum

Office or facility?

Work RVUs
10.53
Total RVUs
15.11
Global days
000

National rate · 2026

$504.69

Facility setting, before claim adjustments.

See every locality for 11004 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 11004 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 11004 covers

This code describes operative debridement of skin, subcutaneous tissue, muscle, and fascia in the external genitalia and perineum for a necrotizing soft-tissue infection. A surgeon, commonly a general surgeon or urologist depending on the involved anatomy, may perform it urgently in a hospital operating room. Fournier gangrene is a characteristic clinical situation. The code is distinguished by the infection and the treated anatomic region, not simply by the depth or surface area of an ordinary wound.

Select this code when the operative report supports necrotizing infection debridement in the genital-perineal region. Document the diagnosis, anatomic sites treated, and tissues removed; this helps distinguish the service from abdominal-wall debridement or wound debridement codes. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 11004 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

11004 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$463.69
AlaskaUnavailable$654.09
ArizonaUnavailable$491.94
ArkansasUnavailable$458.76
Atlanta, GAUnavailable$521.29
Austin, TXUnavailable$502.08
Bakersfield, CAUnavailable$491.57
Baltimore area, MDUnavailable$533.10
Beaumont, TXUnavailable$492.27
Brazoria, TXUnavailable$491.18

11004 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
11004 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 11004 rate is calculated

Each of 11004’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 11004

RVUs × geographic indexes × conversion factor

Office or facility?

Work10.53

10.53 RVUs× 1.000 GPCI

Practice expense2.46

2.46 RVUs× 1.000 GPCI

Malpractice2.12

2.12 RVUs× 1.000 GPCI

Adjusted RVUs

15.1100

Conversion factor

$33.4009

Medicare rate

$504.69

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 11004

The CMS indicators that decide how 11004 is paid alongside other services.

CMS payment indicators · 11004

Infection debridement, external genitalia and perineum

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

11004 without 51 · national facility

$504.69

Infection debridement, external genitalia and perineum

11004-51 · Second procedure: 50%

$252.35

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

11004 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 11004

    Infection debridement, external genitalia and perineum10.53 wRVU

    Not priced

  • 11005

    NSTI debridement, abdominal wall13.88 wRVU

    Not priced

  • 11006

    Infection debridement, perineum and abdominal wall12.77 wRVU

    Not priced

  • 11042

    Wound debridement, subcutaneous tissue, first 20 sq cm0.98 wRVU

    $132.60

How to choose

11005NSTI debridementAbdominal wall
11005 addresses necrotizing-infection debridement of the abdominal wall. Choose 11004 when the treated region is the external genitalia and perineum.
11006Infection debridementPerineum and abdominal wall
11006 is for necrotizing-infection debridement involving the external genitalia and perineum together with the abdominal wall; 11004 is limited to the genital-perineal region.
11042Wound debridementSubcutaneous tissue, first 20 sq cm
11042 is selected for qualifying subcutaneous wound debridement. 11004 is specific to necrotizing soft-tissue infection debridement in the external genitalia and perineum.

Codes related to 11004

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 11004
CodeHow it relatesNational office range
Same family
11005NSTI debridement, abdominal wallRelated necrotizing-infection debridement code for abdominal-wall involvement.No office rate
11006Infection debridement, perineum and abdominal wallCovers genitalia, perineum, and abdominal-wall involvement in necrotizing infection debridement.No office rate
Used instead
11042Wound debridement, subcutaneous tissue, first 20 sq cmFor qualifying subcutaneous wound debridement rather than genital-perineal necrotizing-infection debridement.$117.03–$176.41
11043Wound debridement, muscle or fascia, initial areaFor qualifying muscle or fascia wound debridement outside this code's specific infection and anatomic scope.$213.28–$303.46

11004 billing questions

When should I report 11004 rather than 11005 or 11006?

Use 11004 for necrotizing infection debridement involving the external genitalia and perineum. 11005 describes abdominal-wall involvement, while 11006 covers the genitalia and perineum together with the abdominal wall.

Is this code appropriate for routine wound debridement?

No. This code is for operative debridement for necrotizing soft-tissue infection in the specified genital-perineal region, not routine wound care selected by depth or surface area.

What documentation supports reporting 11004?

Document the necrotizing infection, the external genital or perineal sites treated, and the tissues removed. The operative report should make the scope of debridement clear.

Can modifier 50 be reported?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure's 0-day global period.

Can an assistant or co-surgeon be billed with 11004?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 11004PPRRVU2026_Oct_nonQPP.csv, line 1,242 (RVU26D)

Open CMS sourceHow we calculate rates

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