CPT 11105Surgery

Punch bx skin ea sep/addl

CPT 11105 is used when a doctor takes additional skin samples using a punch biopsy tool during the same visit after the first biopsy. Each additional skin sample from a separate location is billed with this add-on code.

Showing rates for

National Average

Base Medicare rate

$57.58

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.45

PE RVU (NF)

1.27

MP RVU

0.06

Total RVU

1.78

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify number of separate lesions documented - each distinct site beyond the first qualifies for 11105
Impact: $57.58 additional revenue per properly documented site (non-facility); common to miss 1-2 billable sites per encounter
Document exact anatomic location for each biopsy site (e.g., 'right upper back, left forearm, right calf') to support medical necessity
Impact: Reduces denial rate by approximately 40%; prevents $57.58 loss per denied additional biopsy
Never bill 11105 without primary code 11104 - this is an add-on code only and will deny if billed alone
Impact: Prevents 100% denial and claim resubmission costs; 11105 cannot stand alone
Check payer-specific limits on number of punch biopsies per session - some limit to 3-4 total sites without prior authorization
Impact: Prevents denial of excess units; obtain pre-authorization when planning 5+ biopsies to secure $287.90+ in additional revenue
Bill facility vs non-facility rate based on actual place of service - POS 11 (office) yields $57.58 vs POS 22 (outpatient hospital) yields $24.58
Impact: $33.00 difference per biopsy; ensure correct POS code to maximize legitimate reimbursement
For multiple biopsies, consider pathology bundling rules - each specimen should be submitted in separately labeled containers to support separate billing
Impact: Supports medical necessity defense; prevents retrospective denials that could total hundreds of dollars for high-volume practices

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Frequently asked questions

What is CPT code 11105 used for?

CPT 11105 is an add-on code used to report each additional punch biopsy of skin beyond the first biopsy (which is reported with CPT 11104). It's used when a physician takes multiple skin samples from separate lesions or anatomic sites during the same visit.

How much does Medicare pay for CPT 11105 in 2025?

Medicare pays $57.58 for CPT 11105 in non-facility settings and $24.58 in facility settings based on the 2025 Medicare Physician Fee Schedule. The code has 1.78 total RVUs with a work RVU of 0.45.

Can CPT 11105 be billed alone without another code?

No, CPT 11105 cannot be billed alone. It is an add-on code that must be billed with the primary punch biopsy code 11104. Billing 11105 without 11104 on the same claim will result in denial.

How many times can you bill CPT 11105 on the same day?

You can bill CPT 11105 multiple times per session, once for each additional punch biopsy beyond the first. However, you must document each separate anatomic site clearly, and some payers limit the number of biopsies (typically 3-4 total) without prior authorization.

What is the difference between CPT 11104 and 11105?

CPT 11104 is for the first punch biopsy of skin and is the primary code, while CPT 11105 is the add-on code for each additional punch biopsy performed during the same session. 11104 must always be billed first, followed by 11105 for each additional site.

Do I need a modifier when billing CPT 11105?

Modifiers are not always required for 11105, but modifier 59 or XS may be needed if payers question whether the biopsies were truly distinct procedures. Laterality modifiers (LT/RT) can help with documentation but don't affect payment.

What documentation is needed to support billing multiple punch biopsies?

Documentation must include the exact anatomic location of each biopsy site, clinical indication for each separate biopsy, description of each lesion, confirmation that specimens were placed in separate labeled containers, and the total number of biopsies performed. A body diagram is highly recommended.