2025 CPT code 11105
(Active) Effective Date: N/A Revision Date: N/A Surgery - Biopsy Procedures on the Skin Integumentary System Feed
Punch biopsy of skin; each separate/additional lesion.
Modifiers may be applicable depending on the circumstances of the procedure.For example, modifier 59 (distinct procedural service) might be used if the additional biopsies are performed on separate lesions far from the primary lesion.Consult the official CPT manual for appropriate modifier use.
Medical necessity is established when a patient presents with a suspicious lesion requiring histological evaluation to rule out malignancy or to diagnose other dermatological conditions.The decision to perform multiple biopsies should be based on clinical judgment considering the number, size, and location of lesions.
The clinical responsibility lies with the physician or qualified healthcare professional performing the biopsy. This includes proper patient preparation, anesthesia administration, biopsy technique execution, specimen handling, and appropriate documentation.
In simple words: This code means the doctor took an extra skin sample from a different spot using a small, round tool. This is done to find out what's wrong with the skin. This is only for extra samples after a first sample has already been taken.
This CPT code, 11105, represents a punch biopsy of an additional or separate skin lesion, performed using a sharp hollow instrument.It is reported in addition to code 11104 for the initial lesion. The procedure involves removing a cylindrical tissue sample for diagnostic examination. Simple closure of the defect is included.This code is used when multiple punch biopsies are performed on different lesions during the same encounter.
Example 1: A patient presents with multiple suspicious nevi (moles). The physician performs a punch biopsy on the largest lesion (11104) and subsequently performs punch biopsies on two smaller lesions (11105 x 2)., A patient with psoriasis has multiple plaques on their back. The physician performs a punch biopsy on one plaque (11104) and additional biopsies on two other plaques to assess the extent of inflammation (11105 x 2)., A patient presents with a suspicious skin lesion. The dermatologist performs an incisional biopsy (11106) and then performs a punch biopsy on a separate lesion for comparison (11105).
** This code is an add-on code and should always be reported in addition to the primary biopsy code (11104 in this case).Accurate documentation is crucial for proper reimbursement.
- Revenue Code: P6C (Minor Procedures - Other)
- RVU: The RVUs for this code will vary depending on the geographic location and other factors. Consult the current Medicare Physician Fee Schedule for details.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is not applicable to this code.
- Fee Schedule: Historical fee schedule data can be obtained from publicly available resources like the Centers for Medicare & Medicaid Services (CMS) website.
- Specialties:Dermatology, General Surgery, Plastic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)