CPT 11106Surgery

Incal bx skn single les

CPT 11106 covers an incisional skin biopsy of a single lesion, where the provider removes a portion of a suspicious skin growth using a scalpel or punch tool for laboratory analysis. This is an add-on code used when biopsying additional lesions beyond the first one.

Showing rates for

National Average

Base Medicare rate

$148.47

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

1.01

PE RVU (NF)

3.45

MP RVU

0.13

Total RVU

4.59

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify CPT 11105 is billed as primary code before submitting 11106; most payer systems auto-deny 11106 without parent code on same claim
Impact: Prevents 100% denial - difference between $0 and $54.67-$148.47 per additional lesion
Document exact anatomic location and distinct nature of each lesion biopsied; use specific body site descriptors (e.g., 'left upper back 2cm lateral to spine' vs 'right forearm volar surface')
Impact: Reduces audit risk and supports medical necessity for multiple biopsies; critical for modifier 59/XS justification
Bill facility vs non-facility place of service correctly: office setting (POS 11) yields $148.47 while hospital outpatient (POS 22) or ASC (POS 24) yields $54.67
Impact: $93.80 difference per lesion in Medicare reimbursement based solely on accurate POS coding
List units of service rather than multiple line items for same-day additional lesions when payer system allows; review individual payer policy on unit reporting
Impact: Streamlines claims processing and reduces coordination of benefits complications; some payers require separate lines for tracking
Link distinct ICD-10 codes to each lesion when possible (different anatomic sites support separate diagnoses like D22.71 vs D22.62)
Impact: Strengthens medical necessity documentation and reduces bundling risk; supports higher volume biopsy sessions
Verify global period interaction when performed within 10 days of related procedure; 11106 has 10-day global period
Impact: Prevents surprise denials for related services; proper modifier 79 use captures otherwise lost revenue

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 11106?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the difference between CPT 11106 and 11105?

CPT 11105 is the primary code for the first incisional skin biopsy performed, while 11106 is an add-on code for each additional lesion biopsied during the same session. You must always bill 11105 first; 11106 cannot be billed alone. For example, if three lesions are biopsied, you would bill 11105 x1 and 11106 x2.

How much does Medicare pay for CPT 11106 in 2025?

Medicare pays $148.47 for CPT 11106 in non-facility settings (physician office) and $54.67 in facility settings (hospital outpatient or ASC) based on 2025 national average rates. Actual payment varies by geographic locality and MAC jurisdiction.

Can CPT 11106 be billed multiple times on the same day?

Yes, CPT 11106 can be billed multiple times per session for each additional lesion beyond the first, with proper documentation. Each use of 11106 must represent a distinct, separate lesion at a different anatomic site. Most payers allow reporting by units or multiple line items, though documentation must support the count.

What documentation is needed to bill CPT 11106?

Documentation must include specific anatomic location of each lesion, clinical description justifying biopsy, biopsy technique used, confirmation that specimens were submitted separately, and medical necessity for multiple biopsies. The operative note must clearly show that 11105 was also performed and that each lesion represents a distinct site.

Does CPT 11106 require a modifier?

Not routinely, but modifier 59 or XS may be needed when biopsying anatomically distinct sites to prevent inappropriate bundling under NCCI edits. Modifier 79 is required if performed during the postoperative period of an unrelated procedure. LT/RT modifiers may be used for laterality documentation but are not typically required by payers.

What is the RVU value for CPT 11106?

CPT 11106 has a total RVU of 4.59 for 2025, comprising 1.01 work RVU, 3.45 non-facility PE RVU (0.55 facility PE RVU), and 0.13 malpractice RVU. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare payment rates of $148.47 non-facility and $54.67 facility.

Can CPT 11106 be billed with an E/M code on the same day?

Yes, an E/M service can be billed with CPT 11106 if significant, separately identifiable evaluation and management beyond the decision for biopsy is documented. Use modifier 25 on the E/M code. However, the E/M must represent a distinct service such as evaluation of other conditions or comprehensive assessment beyond the lesion examination that led to the biopsy decision.