Billing code 11004: Infection debridementMedicare rate & RVUs in Illinois
Reports operative removal of infected, nonviable tissue from the external genitalia and perineum for necrotizing soft-tissue infection, such as Fournier gangrene.
CMS doesn’t publish an office rate for 11004 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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 Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $599.26 |
| East St. Louis | Unavailable | $569.92 |
| Rest Of Illinois | Unavailable | $537.41 |
| Suburban Chicago | Unavailable | $564.03 |
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
Swap in your local Medicare rate.
Work 10.53Practice expense 2.46Malpractice 2.12
All indexes start 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
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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
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%).
11004 compared with similar codes
Compare codes
11004 vs 11005 vs 11006 vs 11042: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11005NSTI debridement
- 11005 addresses necrotizing-infection debridement of the abdominal wall. Choose 11004 when the treated region is the external genitalia and perineum.
- 11006Infection debridement
- 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 debridement
- 11042 is selected for qualifying subcutaneous wound debridement. 11004 is specific to necrotizing soft-tissue infection debridement in the external genitalia and perineum.
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
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