Summary & Overview
CPT 11105: Additional Punch Biopsy of Skin Lesion
CPT code 11105 denotes an additional or separate punch biopsy of the skin performed with a sharp hollow instrument and is reported per lesion in addition to the primary punch biopsy code. Punch biopsies are commonly used to obtain full-thickness circular samples of skin for diagnostic evaluation of deeper or suspicious lesions. Nationally, accurate reporting of additional lesion biopsies affects claims adjudication, clinical documentation, and procedure-level utilization metrics for dermatologic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical usage and coding context for 11105, comparisons to closely related codes such as 11104 and 11106, and guidance on typical settings where the procedure is performed. The publication summarizes common billing considerations and the clinical scenarios that prompt use of additional punch biopsies, providing stakeholders with a clear understanding of how the code is applied in practice. It also outlines expected documentation elements and national-level significance for procedural tracking and reimbursement workflows.
This summary is intended for a national audience of clinical administrators, coding professionals, and policy analysts seeking a focused briefing on the role and implications of CPT code 11105.
Billing Code Overview
CPT code 11105 describes a punch biopsy of an additional or separate skin lesion performed with a sharp hollow instrument. This code is reported for each separate or additional lesion biopsied after the primary punch biopsy procedure.
Service Type: Skin biopsy (punch) for additional lesion
Typical Site of Service: Outpatient dermatology clinic or office-based setting, including procedure rooms where minor dermatologic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to a dermatology clinic with multiple discrete, suspicious skin lesions identified on the forearm and trunk during the same visit. After clinical examination and dermatoscopic evaluation, the clinician performs a primary punch biopsy of the most suspicious lesion using 11104 (including simple closure). During the same encounter the clinician biopsies an additional separate lesion with a punch technique and reports this additional lesion with 11105. The procedure is performed in an outpatient dermatology clinic or a physician office equipped for minor surgical procedures. Local anesthesia is administered, tissue is obtained with a sharp hollow punch instrument, hemostasis is achieved, and samples are submitted to pathology. Documentation includes lesion location, size, indication (e.g., evaluate for malignancy or atypia), consent, anesthesia, technique, number of lesions biopsied, and specimen labeling corresponding to each CPT and associated ICD-10 diagnosis codes such as L82.1 or C44.99 as appropriate. Typical workflow includes triage, focused skin exam, photography/diagram of lesion sites, performance of 11104 for the primary lesion, and billing of one or more 11105 codes for each separate additional punch biopsy performed during the same session.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of a procedure | Use when a distinct evaluation or management visit is provided on the same day as 11104/11105 and properly documented |
59 | Distinct procedural service | Use to indicate a separate lesion or distinct procedure when payer requires a distinct procedural modifier instead of 11105 sequencing; exercise payer-specific guidance |
51 | Multiple procedures | Use when multiple procedures are performed during the same session and payer requires reporting of multiple-procedure reduction (often more relevant when bundling rules apply) |
52 | Reduced services | Use when a punch biopsy is partially reduced or not completed as originally planned |
53 | Discontinued procedure | Use when the biopsy was started but discontinued for patient safety reasons |
51 | Multiple procedures | Use when reporting multiple different procedures on the same day (note: billing of additional punch biopsies uses 11105 rather than repeating 11104 for each additional lesion) |
59 | Distinct procedural service | Use when documentation supports that procedures are separate and modifier 11105 sequencing is not accepted by the payer |
76 | Repeat procedure by same physician | Use when a repeat punch biopsy of the same lesion is performed later the same day |
77 | Repeat procedure by another physician | Use when a repeat punch biopsy of same lesion is performed by a different physician the same day |
RT | Right side | Use to designate right-sided lesion when laterality is required |
LT | Left side | Use to designate left-sided lesion when laterality is required |
59 | Distinct procedural service | Use when lesions are in distinct anatomical sites and payer requires modifier for separate service |
22 | Increased procedural services | Use when the procedure required significantly more work than typical and documentation supports unusual effort |
52 | Reduced services | Use for partially reduced service when less than the full procedure was performed |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207N00000X | Dermatology Physician | Primary specialty performing skin punch biopsies in-office or clinic settings |
207Q00000X | Family Medicine Physician | Performs punch biopsies in primary care settings for diagnostic evaluation |
207R00000X | Internal Medicine Physician | Performs punch biopsies in outpatient internal medicine clinics or consultative settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L98.9 | Disorder of the skin and subcutaneous tissue, unspecified | Non-specific skin disorder where punch biopsy may be used to obtain diagnostic tissue |
D48.5 | Neoplasm of uncertain behavior of skin | Biopsy indicated to determine behavior (benign vs malignant) of a suspicious cutaneous growth |
L82.1 | Other seborrheic keratosis | Common benign lesion that may be biopsied when atypical features raise concern for malignancy |
L91.8 | Other hypertrophic disorders of the skin | Biopsy may be performed to characterize hypertrophic or scarring processes |
C44.99 | Other specified malignant neoplasm of skin | Biopsy indicated to confirm cutaneous malignancy or to subtype a suspected skin cancer |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11104 | Punch biopsy of skin (including simple closure, when performed) | Primary code for the initial punch biopsy; 11105 is reported for each additional separate lesion after 11104 |
11106 | Incisional biopsy of skin (eg, wedge) (including simple closure, when performed) | Alternative biopsy technique for larger or wedge-shaped lesions; may be selected instead of punch biopsy based on lesion characteristics |