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CPT 11104: Punch Biopsy of Skin Lesion, Full-Thickness Circular Sample
CPT code 11104 denotes a punch biopsy of a skin lesion, a common minor surgical procedure that yields a full-thickness circular specimen for histopathologic diagnosis. This code is nationally relevant because punch biopsies are a frontline diagnostic tool in dermatology and primary care for evaluating inflammatory conditions, suspicious neoplasms, and other deeper skin abnormalities. Accurate coding of biopsy procedures affects clinical documentation, pathology workflow, and reimbursement for ambulatory surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for punch biopsies, typical sites of service, and how CPT code 11104 is positioned relative to related procedure codes for additional lesions or closures. The publication highlights common coding relationships and considerations that influence billing workflows and claims adjudication. It also outlines relevant ICD-10 diagnosis groupings commonly associated with biopsy indications, and references closely related CPT code 11105 for additional lesions. The content serves clinicians, coding professionals, and practice managers seeking a clear, national-level summary of what CPT code 11104 represents, why it matters in outpatient dermatologic care, and where it fits within routine procedural coding.
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Billing Code Overview
CPT code 11104 describes a punch biopsy of a skin lesion performed with a sharp hollow instrument to obtain a full-thickness circular tissue sample. This procedure is typically used for deeper, circular skin lesions when a sample of epidermis and dermis is required for diagnostic evaluation.
Service type: Skin biopsy (punch technique)
Typical site of service: Outpatient clinic or dermatology office, including primary care or specialty dermatology settings where minor surgical dermatologic procedures are performed.
National Reimbursement Benchmarks
Nationally, Medicare’s mean reimbursement for CPT 11104 sits at $126, while BUCA’s mean commercial rate is $220.8, meaning BUCA averages about $94.8 higher than Medicare. This gap highlights a substantial differential between a broad commercial benchmark and the federal program’s mean for this code.
Dispersion (P75–P25) varies across payers: Blue Cross Blue Shield has the widest interquartile spread at $113 (P75 $356.7 minus P25 $225.4), followed by UnitedHealth Group at $109.1, and BUCA at $124 (P75 $281.3 minus P25 $158.7) — BUCA’s numeric range is actually the largest of these. Aetna and Cigna show tighter spreads of $88 and $118.1 respectively, indicating relatively more concentrated commercial pricing for CPT 11104.