CPT 11103 Tangential Skin Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 11103: Tangential Skin Biopsy for Each Additional Lesion

CPT 11103 designates a tangential (shave or curette-type) biopsy performed on each additional separate skin lesion. Nationally, this code is central to outpatient dermatologic practice for diagnosing benign and other superficial skin lesions without full-thickness excision. Its proper use affects billing accuracy, coding compliance, and documentation of lesion-specific services.

The analysis covers major national payers: Aetna; Blue Cross Blue Shield plans; Cigna Health; Medicare; and UnitedHealthcare. Readers will find a concise overview of clinical context for tangential biopsies, comparisons to single-lesion coding, and guidance on documentation elements that typically support use of an additional-lesion code. The content also highlights common procedural settings and the procedural relationship to other dermatologic excisions.

This publication provides benchmarks and policy context relevant to coding and billing teams, practice administrators, and clinicians involved in outpatient dermatologic procedures. It summarizes typical sites of service, clinical scenarios where tangential biopsies are used, and the distinctions between single-lesion and multiple-lesion coding for accurate charge capture. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 11103dermatologyskin biopsytangential biopsyoffice procedurescodingsurgical pathologyprocedure documentation

CPT Code Overview

CPT 11103 describes a tangential biopsy of the skin (for example, shave, scoop, saucerize, curette) performed on each separate or additional lesion. This procedure is classified under Dermatology / Surgical procedures on the skin and typically occurs in an office setting (POS 11). The code covers surgical removal of superficial skin lesions using tangential techniques for diagnostic or therapeutic purposes.

Clinical & Coding Specifications

Clinical Context

A middle-aged patient presents to a dermatology clinic with one or more raised, well-circumscribed benign-appearing skin lesions on the forearm and lower leg. The clinician evaluates the lesions during an office visit (POS 11), documents lesion size, appearance, and location, and discusses options for diagnostic removal. A tangential (shave/scoop/saucerize/curette) biopsy is performed for each separate lesion to obtain tissue for histopathologic examination. The procedure is performed under local anesthesia with minor hemostasis as needed. Specimens are submitted to pathology with site-specific labels and accompanying clinical indications matching the recorded ICD-10 diagnosis codes.

Coding Specifications

Modifier 59 (Distinct Procedural Service): Use when the tangential biopsy represented by 11103 is distinct or separate from other procedures performed at the same encounter and documentation supports separate anatomic sites or separate lesions beyond routine bundling rules.
Modifier 51 (Multiple Procedures): Use when multiple surgical procedures are performed during the same session; apply payer-specific rules for multiple procedure payment reductions when 11103 is reported in combination with other procedures.
Associated Provider Taxonomies:

National Reimbursement Benchmarks

Medicare mean allowed rate for CPT 11103 is $50.61, which is modestly lower than the BUCA (average commercial) mean of $54.21. The difference between Medicare and BUCA mean rates is $3.60, indicating that commercial averages are slightly higher than Medicare for this code.

Dispersion measured as the interpercentile range (P75 − P25) varies across payers. UnitedHealth Group shows the widest spread at $38.00 (P75 $85.00 − P25 $47.00), followed by Cigna at $33.00. Blue Cross Blue Shield and BUCA have moderate dispersion at $21.60 and $27.28 respectively, while Aetna's range is $23.50. Medicare is the tightest with a range of $6.00. The table and chart below present the full breakdown.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide rate spread for CPT code 11103, with the highest 75th percentile rate at $170.00 (Aetna) and the lowest 25th percentile at $46.00 (Medicare), resulting in a spread of $124.00. This indicates significant variation in reimbursement depending on payer, with commercial payers generally offering much higher rates than Medicare. The commercial payer rates in Alaska are notably above the national averages, with Aetna, UnitedHealth Group, Blue Cross Blue Shield, and Cigna all reimbursing at levels well above their respective national mean rates.

The table and chart below present the full breakdown of mean, 25th, 50th, and 75th percentile rates for each major payer in Alaska. This detailed comparison highlights the substantial differences in reimbursement across payers within the state.

Key Insights for Alaska

Aetna is the highest paying payer for CPT 11103 in Alaska, with a mean rate of $156.26, while Medicare is the lowest at $48.82.
All commercial payers in Alaska reimburse significantly above their respective national averages for CPT 11103.
The rate spread between payers is substantial, with Aetna's mean rate more than triple that of Medicare.

CPT 11107: Biopsy of Each Additional Skin Lesion

11104-PUNCH-BIOPSY-OF-SKIN-INCLUDING-SIMPLE-CLOSURE-WHEN

CPT 11104: Punch Biopsy of Skin, Single Lesion

11106-INCISIONAL-BIOPSY-OF-SKIN-EG-WEDGE-INCLUDING-SIMPLE-CLOSURE

CPT 11106: Incisional Biopsy of Skin with Simple Closure

11102-BIOPSY-OF-SKIN-SINGLE-LESION-TANGENTIAL-SHAVE-UNLESS

CPT 11102: Tangential (Shave) Biopsy of Single Skin Lesion

11105-PUNCH-BIOPSY-OF-SKIN-INCLUDING-SIMPLE-CLOSURE-WHEN

CPT 11105: Punch Biopsy of Skin for Additional Lesions

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Related CPT Codes

CPT Code	Description
`11102`	Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion

11102 is a single-lesion tangential biopsy code used when only one lesion is removed. 11103 is used for each separate/additional lesion beyond the single lesion reportable with 11102. In clinical workflow, 11102 and 11103 are alternatives depending on lesion count; 11103 is commonly reported multiple times for additional lesions when more than one tangential biopsy is performed in the same encounter.

National Reimbursement Benchmarks

National Mean Allowed Rates for CPT `11103` by Payer

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Mean CPT 11103 Reimbursement Rates by Payer in Alaska

Key Insights for Alaska

Aetna is the highest paying payer for CPT 11103 in Alaska, with a mean rate of $156.26, while Medicare is the lowest at $48.82.
All commercial payers in Alaska reimburse significantly above their respective national averages for CPT 11103.
The rate spread between payers is substantial, with Aetna's mean rate more than triple that of Medicare.

CPT 11107: Biopsy of Each Additional Skin Lesion

11104-PUNCH-BIOPSY-OF-SKIN-INCLUDING-SIMPLE-CLOSURE-WHEN

CPT 11104: Punch Biopsy of Skin, Single Lesion

11106-INCISIONAL-BIOPSY-OF-SKIN-EG-WEDGE-INCLUDING-SIMPLE-CLOSURE

CPT 11106: Incisional Biopsy of Skin with Simple Closure

11102-BIOPSY-OF-SKIN-SINGLE-LESION-TANGENTIAL-SHAVE-UNLESS

CPT 11102: Tangential (Shave) Biopsy of Single Skin Lesion

11105-PUNCH-BIOPSY-OF-SKIN-INCLUDING-SIMPLE-CLOSURE-WHEN

CPT 11105: Punch Biopsy of Skin for Additional Lesions

`207N00000X`	Dermatology Physician
`207ND0101X`	MOHS-Micrographic Surgery Physician
`207Q00000X`	Family Medicine Physician

OpenPayer

Summary & Overview

CPT 11103: Tangential Skin Biopsy for Each Additional Lesion

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes