Summary & Overview
CPT 11107: Biopsy of Each Additional Skin Lesion
CPT code 11107 represents the biopsy of each separate or additional skin lesion, performed in addition to a primary skin biopsy procedure. This code is significant in dermatology and related specialties, as it allows for precise billing and documentation when multiple lesions are sampled during a single patient encounter. The procedure is commonly performed in office settings and is critical for diagnosing a range of skin conditions, including both benign and malignant lesions.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Understanding the application and reimbursement policies for CPT code 11107 is important for providers, billing professionals, and healthcare administrators, as it impacts claims processing and compliance across these insurers.
Readers will gain insight into the clinical context of skin biopsy procedures, relevant coding benchmarks, and recent policy updates affecting the use of CPT code 11107. The publication also highlights associated clinical taxonomies and ICD-10 diagnoses, providing a comprehensive overview of how this code fits into broader dermatology practice and medical billing workflows.
CPT Code Overview
CPT code 11107 is used to report biopsy procedures on the skin for each separate or additional lesion, listed separately in addition to the code for the primary procedure. This code is typically utilized in office settings, where physicians perform skin biopsies to obtain tissue samples for diagnostic evaluation. The procedure is essential for identifying and managing various skin conditions, including benign and malignant lesions. Accurate coding of each additional lesion ensures proper documentation and reimbursement for the complexity and extent of the service provided.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology office with multiple suspicious skin lesions. The provider determines that an incisional or wedge biopsy is necessary to evaluate the lesions for possible malignancy or other skin disorders. The provider performs a biopsy on the primary lesion using CPT code 11106, and then biopsies each additional lesion using CPT code 11107. This workflow is typical in office settings, where multiple lesions require separate pathological evaluation.
Coding Specifications
- Modifier
+11107: Used to report each separate/additional lesion biopsied beyond the primary lesion. This modifier is listed in addition to the code for the primary procedure.
| Modifier Code | Description |
|---|---|
+11107 | Each separate/additional lesion (add-on code) |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207N00000X | Dermatology Physician |
207ND0101X | MOHS-Micrographic Surgery Physician |
207Q00000X | Family Medicine Physician |
Related Diagnoses
-
D23.111: Description not provided. This code is relevant for benign neoplasm of skin of right upper eyelid, which may require biopsy to rule out malignancy. -
D23.112: Description not provided. This code is relevant for benign neoplasm of skin of left upper eyelid, which may require biopsy for diagnostic purposes. -
D23.121: Description not provided. This code is relevant for benign neoplasm of skin of right lower eyelid, which may be biopsied to assess for potential malignancy or other pathology. -
D23.122: Description not provided. This code is relevant for benign neoplasm of skin of left lower eyelid, which may necessitate biopsy for further evaluation.
Each of these ICD-10 codes represents a benign skin lesion in specific eyelid locations, clinically relevant for biopsy procedures to confirm diagnosis or rule out malignancy.
Related CPT Codes
11106: The provider biopsies a skin lesion using an incisional or wedge technique; this code is used for the primary lesion.
Clinical Relationship:
CPT code 11106is used for the first lesion biopsied.CPT code 11107is used for each additional lesion biopsied during the same encounter.- These codes are commonly used together when multiple lesions are biopsied in a single visit.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 11107 is $73.45, closely aligned with the BUCA (average commercial) mean rate of $72.35. Among commercial payers, UnitedHealth Group has the highest mean rate at $99.07, while Aetna is the lowest at $50.08.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $8.00, indicating relatively consistent reimbursement. In contrast, Cigna and UnitedHealth Group show the widest dispersions, with ranges of $43.75 and $52.00 respectively, reflecting greater variability in rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 11107, with the highest payer (Aetna) offering a mean rate of $213.78 and the lowest (Medicare) at $70.91. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Aetna, where all percentiles are equal at $241.50, indicating a lack of variability. Other payers, such as Blue Cross Blue Shield and UnitedHealth Group, show more typical spreads, with BCBS ranging from $112.73 to $157.80 and UnitedHealth Group from $147.50 to $165.15.
Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates. For example, Aetna's mean rate in Alaska is over four times its national mean, and UnitedHealth Group's mean rate is more than 50% higher than its national average. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 11107 in Alaska, with a mean rate of $213.78.
- Medicare is the lowest paying payer, with a mean rate of $70.91.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Aetna's mean rate more than four times the national mean.
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