CPT 11042: wound debridement, down to subcutaneous tissue. What Medicare pays and what to ask
Wound care bills depend on depth and size. Here is what 11042 covers and what Medicare pays.
What this code means
CPT 11042 is the removal of damaged tissue from a wound down to the layer under the skin, for the first 20 square centimeters. Each additional 20 square centimeters uses an add-on code, 11045.
It is common in wound care and diabetic foot care.
Why the bill can be much higher than the Medicare rate
The code depends on how deep the tissue removal went and on the wound size, so the medical notes matter.
Wound care visits can add supplies and a facility fee.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $663.00 |
| 10x the Medicare rate | $1,326.00 |
| 20x the Medicare rate | $2,652.00 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- How deep was the debridement and how large was the wound, and does the code match the notes?
- Are add-on lines billed, and for what area?
- Is a visit billed on the same day, and why?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.