CPT code 11005: NSTI debridement, abdominal wall2026 Medicare rate & RVUs in Maryland
Report this service when a surgeon removes infected or necrotic skin, subcutaneous tissue, muscle, and fascia for a necrotizing soft tissue infection of the abdominal wall.
CMS doesn’t publish an office rate for 11005 in Maryland.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 11005 covers
This code describes operative debridement for a necrotizing soft tissue infection involving the abdominal wall, such as necrotizing fasciitis. The surgeon removes infected or necrotic skin, subcutaneous tissue, muscle, and fascia. It is typically performed in a hospital operating room when urgent source control is needed; the operative report should identify the abdominal-wall involvement and the tissues actually debrided.
Select this code for the abdominal wall alone, not by measuring wound surface area or choosing the deepest tissue level as with routine wound-debridement codes. Document the infection, anatomic extent, and debridement performed. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this code. An assistant at surgery is payable only when medical necessity is documented; 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 11005 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $735.78 |
| Rest of Maryland | Unavailable | $689.29 |
| Washington, DC area | Unavailable | $751.06 |
How the 11005 rate is calculated
Each of 11005’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 · 11005
RVUs × geographic indexes × conversion factor
Work13.88
13.88 RVUs× 1.000 GPCI
Practice expense3.41
3.41 RVUs× 1.000 GPCI
Malpractice3.45
3.45 RVUs× 1.000 GPCI
Adjusted RVUs
20.7400
Conversion factor
$33.4009
Medicare rate
$692.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 11005
The CMS indicators that decide how 11005 is paid alongside other services.
CMS payment indicators · 11005
NSTI debridement, abdominal wall
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
11005 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 11004Infection debridementExternal genitalia and perineum
- Use 11004 for necrotizing infection debridement of the external genitalia and perineum without abdominal-wall involvement; 11005 is for the abdominal wall.
- 11006Infection debridementPerineum and abdominal wall
- Use 11006 when debridement for the necrotizing infection involves the abdominal wall together with the external genitalia and perineum.
- 11042Wound debridementSubcutaneous tissue, first 20 sq cm
- Use 11042 for qualifying routine wound debridement through subcutaneous tissue, based on tissue depth and area; 11005 is specific to abdominal-wall necrotizing infection.
- 11043Wound debridementMuscle or fascia, initial area
- Use 11043 for qualifying routine wound debridement involving muscle or fascia, based on tissue depth and area, rather than the NSTI-specific abdominal-wall service.
11005 billing questions
When should I report 11005 rather than 11004 or 11006?
Use 11005 when the necrotizing soft tissue infection and debridement involve the abdominal wall alone. Code 11004 describes the external genitalia and perineum; 11006 covers those areas together with the abdominal wall.
Is code selection based on wound size or the deepest tissue removed?
No. This code is specific to necrotizing soft tissue infection of the abdominal wall and is not selected by surface area or a deepest-tissue level.
Can removal of infected abdominal-wall mesh be reported separately?
When infected prosthetic material or mesh is removed from the abdominal wall, 11008 is an add-on reported with the applicable primary debridement code, including 11005 when appropriate.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
What documentation supports reporting 11005?
The operative report should establish necrotizing soft tissue infection of the abdominal wall, identify the extent and tissues involved, and describe the debridement 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.
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