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

CMS doesn’t publish an office rate for 11004 in California.

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

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 in California

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

29 of 29 payment localities

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.

Payment rules and modifiers for 11004

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

What modifiers do to the payment

When to use modifier 51

11004 compared with similar codes

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.

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

Open CMS sourceHow we calculate rates