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CPT 11106: Incisional or Wedge Biopsy of Skin Lesion
CPT code 11106 denotes an incisional or wedge biopsy of a skin lesion, used to sample large or deep lesions when complete excision is not feasible. Nationally, this code is important for accurate clinical documentation, correct procedure selection, and appropriate claims processing for dermatologic and surgical providers. It captures a distinct surgical approach compared with shave or punch biopsies and can affect billing, coding specificity, and procedure-level quality tracking.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context in which 11106 is used, common ICD-10 diagnostic pairings, and how related procedure coding (including separate reporting for additional lesions) is handled. The publication summarizes payer coverage considerations and common coding relationships to help billing staff and clinical coders recognize when 11106 applies.
This piece provides benchmarks and reference points for coding practice, highlights relevant clinical scenarios for use of an incisional/wedge technique, and outlines related procedural coding (including separate listing for each additional lesion). Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 11106 describes an incisional or wedge biopsy of a skin lesion, a procedure in which the provider removes a portion of a large or deep skin lesion for diagnostic evaluation. This procedure is typically used when a full excision is impractical because of lesion size, depth, or anatomic location.
Service Type: Skin biopsy — incisional/wedge technique
Typical Site of Service: Outpatient dermatology clinic or ambulatory surgical setting
National Reimbursement Benchmarks
Medicare's mean rate of $157.2 sits below BUCA's average commercial mean of $236.5, indicating that commercial benchmarks for CPT 11106 are substantially higher than the federal program's average. The gap of $79.3 between BUCA and Medicare highlights a meaningful differential that payers and analysts typically consider when comparing public versus commercial reimbursement levels.
Dispersion varies markedly across payers: Blue Cross Blue Shield shows the widest interquartile spread with P75–P25 = $131.4 ($374.7 − $234.3), followed by UnitedHealth Group with a spread of $142.3 ($260.6 − $118.3) and Cigna at $142.8 ($225.5 − $83.2). Aetna displays a tighter spread of $103.2 ($141.0 − $40.8). BUCA's interquartile spread is $135.2 ($303.7 − $168.5) and Medicare's is narrow at $18 ($163 − $145).