CPT 11105: Punch Biopsy of Additional Skin Lesion
Medicare pays $63 and commercial payers pay $123 on average nationally for this procedure.
CPT code 11105 describes a punch biopsy of an additional or separate skin lesion performed with a sharp hollow instrument; this represents an additional lesion biopsy reported in conjunction with the primary punch biopsy procedure and is a dermatologic biopsy typically performed in an office or ambulatory surgical setting for evaluation of deeper circular skin lesions.
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National Reimbursement Benchmarks
Medicare’s mean rate for CPT 11105 sits at $62.6, while BUCA’s mean commercial rate is notably higher at $122.6, indicating that average commercial reimbursements from BUCA are roughly $60 greater than Medicare for this code. Blue Cross Blue Shield, Cigna, Aetna, and UnitedHealth Group all show mean rates that span between these two anchors, creating a commercial-to-Medicare spread that clinics will see across payers.
Assessing dispersion via the interquartile range (P75–P25), Blue Cross Blue Shield is the widest with a spread of $75.6 ($202.2–$126.6), followed by UnitedHealth Group at $55.3 ($105.3–$49.7) and Cigna at $55.6 ($90.7–$37.1). Aetna is much tighter with a spread of $41.5 ($63.7–$22.0), and BUCA’s interquartile spread is $64.8 ($152.7–$87.9). These differences highlight which payers exhibit greater variability in middle-range reimbursements versus those with more compressed bands.