Summary & Overview
CPT 11102: Tangential (Shave) Biopsy of Single Skin Lesion
CPT code 11102 represents a tangential ("shave") biopsy of a single skin lesion, a procedure frequently performed in dermatology offices across the United States. This code is integral to the diagnosis and management of various skin conditions, including benign neoplasms, and is widely recognized by major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
The publication provides a comprehensive overview of the clinical context for 11102, including its role in dermatologic surgical procedures and typical site of service. Readers will gain insight into payer coverage, relevant modifiers, associated taxonomies, and common ICD-10 diagnoses linked to this code. Additionally, the article highlights related CPT codes, such as 11103, which covers biopsies of additional lesions using the same technique.
Healthcare professionals and policy analysts will find benchmarks, policy updates, and billing considerations relevant to 11102, supporting accurate documentation and reimbursement practices. The summary also addresses the importance of this code in national billing standards and its impact on patient care within dermatology and related specialties.
CPT Code Overview
CPT code 11102 is used to report the biopsy of skin for a single lesion using a tangential, or "shave," technique. This procedure is commonly performed in dermatology settings to obtain a sample of skin tissue for diagnostic purposes. The service type falls under Dermatology / Surgical Procedures on the Skin, and the typical site of service is a dermatology office (Place of Service 11). This code is essential for accurately documenting and billing skin biopsy procedures performed on a single lesion.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology office with a single skin lesion on the eyelid, such as a benign neoplasm. The dermatologist evaluates the lesion and determines that a tangential ("shave") biopsy is necessary to obtain a tissue sample for diagnostic purposes. The procedure is performed in the office setting, typically under local anesthesia. The workflow includes pre-procedure assessment, informed consent, the biopsy itself, and post-procedure care instructions. If an evaluation and management service is performed on the same day, it may be documented separately.
Coding Specifications
- Modifier
25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the procedure. This modifier is appended to the E/M code, not the procedure code.
| Provider Taxonomy Code | Specialty |
|---|---|
207N00000X | Dermatology |
207Q00000X | Family Medicine |
207R00000X | Internal Medicine |
- Dermatology: Specialists in skin conditions and procedures.
- Family Medicine: Providers who may perform skin biopsies in primary care settings.
- Internal Medicine: Providers who may perform skin biopsies as part of general medical care.
Related Diagnoses
-
D23.111- Other benign neoplasm of skin of right upper eyelid, including canthus- Indicates a benign growth on the right upper eyelid, which may require biopsy to confirm diagnosis.
-
D23.112- Other benign neoplasm of skin of right lower eyelid, including canthus- Represents a benign lesion on the right lower eyelid, relevant for biopsy procedures.
-
D23.121- Other benign neoplasm of skin of left upper eyelid, including canthus- Refers to a benign neoplasm on the left upper eyelid, often biopsied to rule out malignancy.
-
D23.122- Other benign neoplasm of skin of left lower eyelid, including canthus- Describes a benign lesion on the left lower eyelid, clinically relevant for biopsy to determine pathology.
Related CPT Codes
11103- Biopsy of skin; each additional tangential ("shave") lesion
11103 is used in conjunction with 11102 when more than one tangential (shave) skin lesion is biopsied during the same encounter. 11102 covers the first lesion, and 11103 is reported for each additional lesion. These codes are commonly used together when multiple lesions require biopsy.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 11102 is $99.28, which is slightly higher than the BUCA (average commercial) mean rate of $96.63. Among commercial payers, UnitedHealth Group has the highest mean rate at $134.89, while Aetna is the lowest at $80.11. Blue Cross Blue Shield and Cigna fall in between, with mean rates of $92.51 and $115.57, respectively.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range ($103.00 - $92.00 = $11.00), indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest dispersion ($158.75 - $87.67 = $71.08), reflecting greater variability in rates. Cigna also has a wide range ($138.00 - $77.50 = $60.50), while Aetna and Blue Cross Blue Shield have moderate dispersions. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a notably wide range in reimbursement rates for CPT code 11102, with the highest mean rate from Aetna at $292.99 and the lowest from Medicare at $95.75. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Aetna ($61.00), while other payers such as Blue Cross Blue Shield and UnitedHealth Group show more moderate spreads. This variability highlights significant differences in payer reimbursement practices within the state.
Compared to national averages, Alaska's commercial payers consistently offer higher mean rates, with Aetna's mean rate nearly four times the national mean. The table and chart below present the full breakdown of payer-specific rates, including percentiles and mean values, for Alaska.
Key Insights for Alaska
- Aetna is the highest paying payer in Alaska for CPT 11102, with a mean rate of $292.99, while Medicare is the lowest at $95.75.
- All commercial payers in Alaska reimburse significantly above their respective national averages, with Aetna's mean rate nearly four times the national mean.
- The rate spread between the 25th and 75th percentiles is largest for Aetna ($61.00), indicating greater variability compared to other payers.
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