Skin Biopsy: Billing Codes and Payer Rules
Skin Biopsy Coding Overview
Skin biopsy billing uses CPT codes 11102-11107, revised in 2019. The codes are split by biopsy technique: tangential (shave), punch, and incisional. Each technique has a primary code for the first lesion and an add-on code for each additional lesion. Reimbursement ranges from $60 to $180 per biopsy depending on technique and payer.
Biopsy Codes by Technique
| Technique | First Lesion | Each Additional | Typical Reimbursement |
|---|---|---|---|
| Tangential (shave) | 11102 | +11103 | $60-$100 |
| Punch | 11104 | +11105 | $90-$140 |
| Incisional | 11106 | +11107 | $120-$180 |
Add-on codes (+11103, +11105, +11107) can only be billed with their corresponding primary code on the same date. Each additional lesion biopsied using the same technique gets one add-on unit.
Modifier Rules
Use modifier 59 when performing biopsies using different techniques on the same date (e.g., shave biopsy of one lesion + punch biopsy of another). Use modifier 25 on the E/M code if billing an office visit alongside the biopsy. Do not use modifier 59 on add-on codes — they are exempt from NCCI bundling edits.
Common Denials
CO-97 occurs when add-on codes are billed without the corresponding primary code. CO-4 flags incompatible coding when two primary biopsy codes of the same technique are billed (use one primary + add-ons). CO-16 indicates the pathology report does not match the biopsy technique coded. See skin cancer billing for related excision coding.
Common Questions About Skin Biopsy Billing
Can I bill a biopsy and excision of the same lesion on the same day?
Not typically. If you biopsy a lesion and then excise it in the same session, bill only the excision. The biopsy is considered part of the excision. If the biopsy is on a different lesion, bill both with separate diagnosis codes and anatomical modifiers.
Do I bill pathology separately from the biopsy?
Yes. The biopsy CPT code covers the procedure. Pathology interpretation (88305) is billed separately by the pathologist. If the dermatologist also reads the pathology, they bill 88305 with modifier 26 (professional component) under their NPI.
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This reference is for informational purposes. Always verify against current payer policies, CPT guidelines, and CMS documentation. Last updated: 2026-04-06.