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    v1.0.30
    OpenPayerBilling CodesBiopsy Procedures on the SkinCPT cpt-11105-additional-punch-biopsy-skin-lesion
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    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.

    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

    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.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescription

    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…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207N00000X
    207Q00000X
    207R00000X
    261QP2300X
    363L00000X
    363LW0102X
    364SN0000X
    364SE0003X

    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-11103-TANGENTIAL-SHAVE-BIOPSY-ADDITIONAL-LESION

    CPT 11103: Additional Tangential (Shave/Curette) Skin Biopsy

    CPT-11104-PUNCH-BIOPSY-SKIN-LESION

    CPT 11104: Punch Biopsy of 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.
    Published by

    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.

    Relationship to This Procedure
    11104Punch 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
    11106Incisional 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