CPT 11104: Punch Biopsy of Skin Lesion
Medicare pays $126 and commercial payers pay $221 on average nationally for this procedure.
CPT code 11104 describes a punch biopsy of a skin lesion using a sharp hollow instrument to obtain a deeper, circular full-thickness tissue sample; this is a biopsy procedure typically performed in an ambulatory procedure room or dermatology clinic and is used to diagnose or evaluate suspicious or deeper cutaneous lesions.
Customize your policy alerts
Sign up for cpt 11104 policy alerts
Get alerted when payer policies referencing 11104 are released or updated.
Monitor payer policy activity
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.