Summary & Overview
CPT 11107: Additional Incisional/Wedge Skin Lesion Biopsy
CPT code 11107 represents an additional or separate skin lesion biopsy performed using an incisional or wedge technique and is reported in addition to the primary lesion biopsy code 11106. This code captures provider work for biopsying large or deep lesions that require partial sampling rather than complete excision, and it is used when multiple discrete lesions are sampled in the same session. Nationally, accurate reporting of 11107 affects clinical documentation, procedure-level utilization tracking, and appropriate payment for incremental surgical effort.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 11107, common service settings, and how it relates to the primary incisional biopsy code. The publication provides benchmarks and policy-relevant notes about reporting practices, coding guidance on when to append 11107 alongside the primary code, and comparisons across major payers regarding coverage nuances and claim adjudication patterns.
This summary is intended to inform clinicians, billing staff, and policy analysts about the role of CPT code 11107 in surgical dermatology coding workflows, documentation requirements for multiple lesion biopsies, and common considerations when reconciling procedure reporting with payer rules.
Billing Code Overview
CPT code 11107 describes an additional or separate skin lesion biopsy performed using an incisional or wedge technique. This code is reported in addition to the primary lesion biopsy code when a provider biopsies one or more additional or separate lesions during the same encounter.
Service type: Surgical skin biopsy (incisional/wedge) for additional or separate lesions
Typical site of service: Outpatient dermatology clinic, ambulatory surgical center, or physician office where minor surgical dermatologic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female presents to a dermatology clinic with multiple longstanding, clinically suspicious pigmented papules on the dorsal forearm and upper back. The dermatologist performs an initial incisional (wedge) biopsy of the most suspicious lesion using 11106. During the same encounter, the provider identifies an additional, separate larger lesion on the upper back that is deep and not amenable to simple shave technique; the provider obtains an additional incisional/wedge biopsy of that separate lesion and reports +11107 for the extra lesion. The clinical workflow includes pre-procedure consent and counselling, local anesthesia administration, targeted tissue excision using an incisional/wedge technique, specimen labeling and submission to pathology, and post-procedure wound care instructions. Documentation includes lesion location, size, depth, indication for incisional technique (large or deep lesion), separate lesion identification, anesthesia used, and that specimens are separately labeled and sent to pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When the additional biopsy is a separate lesion and not part of the same surgical field as the primary 11106; supports use of for a separately identifiable lesion. |