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    OpenPayerBilling CodesBiopsy Procedures on the SkinCPT cpt-11103-tangential-shave-biopsy-additional-lesion
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    CPT 11103: Additional Tangential (Shave/Curette) Skin Biopsy

    Medicare pays $51 and commercial payers pay $118 on average nationally for this procedure.

    CPT code 11103 reports an additional tangential (shave or curette) biopsy of a separate skin lesion performed in addition to the primary tangential biopsy; this procedure is a dermatologic surgical biopsy service typically performed in an outpatient clinic, dermatology office, or minor procedure room using a sideways shaving or scooping technique to remove a lesion for diagnostic evaluation.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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    National Reimbursement Benchmarks

    National averages place Medicare at a mean of $50.6 and BUCA (average commercial) notably higher at $118.2, indicating commercial contracts represented by BUCA pay on average about $67.6 more than Medicare for CPT 11103. This gap highlights a substantial commercial-to-Medicare premium for this procedure.

    Examining dispersion (P75 minus P25) highlights variability across carriers: Blue Cross Blue Shield has a range of $74.6 (P75 $195.9 minus P25 $121.3), UnitedHealth Group shows a range of $58.9, and BUCA’s interquartile spread is $58.2. Aetna and Cigna are tighter, with ranges of $55.9 and $44.5 respectively. Medicare’s interquartile spread is narrow at $6 (P75 $53 minus P25 $47), reflecting the most compressed distribution among payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old patient presents to a dermatology clinic with multiple raised, pigmented papules on the dorsal surface of the right forearm. The clinician identifies one lesion as the primary target for diagnostic tangential biopsy and performs a shave biopsy reported as 11102. During the same encounter, two additional clinically suspicious benign-appearing lesions on the same arm are sampled using tangential (shave/scoop) technique. Each additional lesion is reported with +11103 in addition to the primary 11102 code. The typical workflow includes lesion inspection, informed consent, local anesthesia (e.g., lidocaine), hemostasis (electrocautery or chemical), specimen labeling and submission to pathology, and brief postoperative instructions. Documentation includes lesion location, size, indication, technique (tangential/shave/curette), number of specimens, and specimen disposition. Typical site of service is an outpatient dermatology clinic, physician office, or ambulatory surgical center where minor skin procedures are performed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11102Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesionPrimary code for a single tangential biopsy; is reported for each additional lesion sampled in the same session

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207N00000X
    207ND0101X
    207Q00000X
    281PC2000X
    207KA0200X
    207RH0005X
    282J00000X
    364SW0102X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-11102-TANGENTIAL-SHAVE-SKIN-BIOPSY-SINGLE-LESION

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

    CPT-11104-PUNCH-BIOPSY-SKIN-LESION

    CPT 11104: Punch Biopsy of Skin Lesion

    CPT-11105-ADDITIONAL-PUNCH-BIOPSY-SKIN-LESION

    CPT 11105: Punch Biopsy of Additional Skin Lesion

    CPT-11106-INCISIONAL-WEDGE-SKIN-BIOPSY

    CPT 11106: Incisional or Wedge Biopsy of Skin Lesion

    CPT-11107-ADDITIONAL-SKIN-LESION-INCISIONAL-WEDGE-BIOPSY

    CPT 11107: Additional Incisional or Wedge Skin Lesion Biopsy

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    11103