Summary & Overview
CPT 11103: Tangential Skin Biopsy for Each Additional Lesion
CPT 11103 designates a tangential (shave or curette-type) biopsy performed on each additional separate skin lesion. Nationally, this code is central to outpatient dermatologic practice for diagnosing benign and other superficial skin lesions without full-thickness excision. Its proper use affects billing accuracy, coding compliance, and documentation of lesion-specific services.
The analysis covers major national payers: Aetna; Blue Cross Blue Shield plans; Cigna Health; Medicare; and UnitedHealthcare. Readers will find a concise overview of clinical context for tangential biopsies, comparisons to single-lesion coding, and guidance on documentation elements that typically support use of an additional-lesion code. The content also highlights common procedural settings and the procedural relationship to other dermatologic excisions.
This publication provides benchmarks and policy context relevant to coding and billing teams, practice administrators, and clinicians involved in outpatient dermatologic procedures. It summarizes typical sites of service, clinical scenarios where tangential biopsies are used, and the distinctions between single-lesion and multiple-lesion coding for accurate charge capture. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 11103 describes a tangential biopsy of the skin (for example, shave, scoop, saucerize, curette) performed on each separate or additional lesion. This procedure is classified under Dermatology / Surgical procedures on the skin and typically occurs in an office setting (POS 11). The code covers surgical removal of superficial skin lesions using tangential techniques for diagnostic or therapeutic purposes.
Clinical & Coding Specifications
Clinical Context
A middle-aged patient presents to a dermatology clinic with one or more raised, well-circumscribed benign-appearing skin lesions on the forearm and lower leg. The clinician evaluates the lesions during an office visit (POS 11), documents lesion size, appearance, and location, and discusses options for diagnostic removal. A tangential (shave/scoop/saucerize/curette) biopsy is performed for each separate lesion to obtain tissue for histopathologic examination. The procedure is performed under local anesthesia with minor hemostasis as needed. Specimens are submitted to pathology with site-specific labels and accompanying clinical indications matching the recorded ICD-10 diagnosis codes.
Coding Specifications
-
Modifier
59(Distinct Procedural Service): Use when the tangential biopsy represented by11103is distinct or separate from other procedures performed at the same encounter and documentation supports separate anatomic sites or separate lesions beyond routine bundling rules. -
Modifier
51(Multiple Procedures): Use when multiple surgical procedures are performed during the same session; apply payer-specific rules for multiple procedure payment reductions when11103is reported in combination with other procedures. -
Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207N00000X | Dermatology Physician |
207ND0101X | MOHS-Micrographic Surgery Physician |
207Q00000X | Family Medicine Physician |
Related Diagnoses
-
D23.111— Other benign neoplasm of skin of right arm, forearm and hand [covering one group from LCD L33445]Clinical relevance: Lesions in this anatomic region may be sampled with a tangential biopsy such as
11103when multiple separate lesions require removal or diagnosis. -
D23.112— Other benign neoplasm of skin of left arm, forearm and handClinical relevance: Lesions on the left upper extremity correspond to sites appropriate for tangential biopsy; multiple lesions on the left arm may be reported with
11103for each additional lesion. -
D23.121— Other benign neoplasm of skin of right lower limb, including hipClinical relevance: Benign cutaneous lesions on the right lower limb are appropriate indications for shave or tangential biopsy techniques billed with
11103when multiple lesions are sampled. -
D23.122— Other benign neoplasm of skin of left lower limb, including hipClinical relevance: Lesions on the left lower extremity that are sampled with shave/tangential biopsy techniques are represented by this diagnosis and by additional lesion reporting using
11103.
Related CPT Codes
| CPT Code | Description |
|---|---|
11102 | Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion |
11102is a single-lesion tangential biopsy code used when only one lesion is removed.11103is used for each separate/additional lesion beyond the single lesion reportable with11102. In clinical workflow,11102and11103are alternatives depending on lesion count;11103is commonly reported multiple times for additional lesions when more than one tangential biopsy is performed in the same encounter.
National Reimbursement Benchmarks
Medicare mean allowed rate for CPT 11103 is $50.61, which is modestly lower than the BUCA (average commercial) mean of $54.21. The difference between Medicare and BUCA mean rates is $3.60, indicating that commercial averages are slightly higher than Medicare for this code.
Dispersion measured as the interpercentile range (P75 − P25) varies across payers. UnitedHealth Group shows the widest spread at $38.00 (P75 $85.00 − P25 $47.00), followed by Cigna at $33.00. Blue Cross Blue Shield and BUCA have moderate dispersion at $21.60 and $27.28 respectively, while Aetna's range is $23.50. Medicare is the tightest with a range of $6.00. The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide rate spread for CPT code 11103, with the highest 75th percentile rate at $170.00 (Aetna) and the lowest 25th percentile at $46.00 (Medicare), resulting in a spread of $124.00. This indicates significant variation in reimbursement depending on payer, with commercial payers generally offering much higher rates than Medicare. The commercial payer rates in Alaska are notably above the national averages, with Aetna, UnitedHealth Group, Blue Cross Blue Shield, and Cigna all reimbursing at levels well above their respective national mean rates.
The table and chart below present the full breakdown of mean, 25th, 50th, and 75th percentile rates for each major payer in Alaska. This detailed comparison highlights the substantial differences in reimbursement across payers within the state.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 11103 in Alaska, with a mean rate of $156.26, while Medicare is the lowest at $48.82.
- All commercial payers in Alaska reimburse significantly above their respective national averages for CPT 11103.
- The rate spread between payers is substantial, with Aetna's mean rate more than triple that of Medicare.
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