- CPT updated certain skin biopsy codes in 2019
- The codes for excision of benign and malignant lesions did not change, and codes for shave biopsies didn’t change. Those are still coded based on the size of the excision and location
- There are still specific biopsy codes in other chapters, for biopsy of ears, lips, genital areas, and other areas. These are code based on size of the lesion and the location
- Now, there are codes for incisional biopsy, punch biopsy and tangential biopsy
Is that all clear? Read on!
In 2019, CPT® deleted codes punch biopsy code 11100 and add-on code +11101 and replaced these codes with six new biopsy codes, that included different methods.
Using these codes indicates that the procedure was:
“to obtain tissue solely for diagnostic histopathologic examination when performed independently, or was unrelated or distinct from other procedures/services provided at the that time.” [1]
These six codes listed below are not defined by location or size, but are defined by the method of obtaining the biopsy. There is no need to wait for pathology when reporting these new codes.
Our billing guide for Minor Surgical Procedures provides an in-depth look at coding guidelines for procedures with 0 to 10 global days, including biopsies.
| Code | Description | 2020 Work RVUs | National non-facility payment | National facility payment | Global Days |
| 11102 |
Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion |
0.66 | $102.49 | $40.42 | 0 |
| +11103 |
each separate/additional lesion (List separately in addition to code for primary procedure) |
0.38 | $54.50 | $23.46 | ZZZ |
| 11104 |
Punch biopsy of skin (including simple closure, when performed) single lesion |
0.83 | $128.84 | $50.53 | 0 |
| +11105 |
each separate/additional lesion (List separately in addition to code for primary procedure |
0.45 | $62.07 | $27.43 | ZZZ |
| 11106 |
Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion |
1.01 | $155.91 | $60.99 | 0 |
| +11107 |
each separate/additional lesion (List separately in addition to code for primary procedure) |
0.54 | $73.62 | $32.84 | ZZZ |
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