CPT 11107Surgery

Incal bx skn ea sep/addl

CPT 11107 is used when a doctor takes additional skin samples (biopsies) during the same visit after the first one. Each extra biopsy from a separate skin lesion gets billed with this add-on code.

Showing rates for

National Average

Base Medicare rate

$67.93

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

0.54

PE RVU (NF)

1.5

MP RVU

0.06

Total RVU

2.1

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

NCCI bundling edits

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Billing tips

Always verify that primary code 11106 is billed first on the same claim; 11107 will deny if billed without the primary code
Impact: Prevents 100% denial - this is an add-on code that cannot stand alone and will be rejected without proper sequencing
Document the exact number and distinct anatomic locations of each separate lesion biopsied to support multiple units of 11107
Impact: Each properly documented additional lesion generates $67.93 (non-facility) or $29.44 (facility) in Medicare revenue
Non-facility setting yields $38.49 more per additional biopsy than facility setting ($67.93 vs $29.44); consider site of service economics
Impact: For 3 additional lesions (3 units of 11107), non-facility generates $115.47 more revenue than facility setting
Do not bill 11107 with shave biopsy codes (11102-11103) or punch biopsy codes (11104-11105); incisional biopsies are a distinct technique
Impact: Mixing biopsy code families typically results in denial or downcoding, potentially losing $30-70 per incorrectly coded lesion
Link each biopsy to a specific ICD-10 code representing the clinical indication; multiple biopsies may have different diagnosis codes
Impact: Specific diagnosis linkage supports medical necessity and reduces audit risk, particularly when billing 4+ units of 11107
Check individual payer policies for maximum units per day; some MACs and commercial payers flag claims with more than 5-6 total biopsies for review
Impact: Proactive documentation and potential pre-authorization for extensive biopsy sessions prevents payment delays on high-dollar claims ($200+)

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Frequently asked questions

How much does Medicare pay for CPT code 11107 in 2025?

Medicare pays $67.93 for CPT 11107 in non-facility settings and $29.44 in facility settings based on the 2025 national average Physician Fee Schedule. Actual payment may vary by geographic locality based on GPCI adjustments.

Can CPT 11107 be billed alone without another code?

No, CPT 11107 is an add-on code that must always be billed with the primary incisional skin biopsy code 11106. It cannot be billed independently and will be denied if submitted without 11106 on the same claim and date of service.

How many times can you bill CPT 11107 on the same day?

You can bill CPT 11107 for each separate and additional skin lesion biopsied beyond the first, with no absolute limit defined by CPT. However, documentation must support the medical necessity for each lesion, and some payers may review claims with more than 5-6 total biopsies for appropriateness.

What is the difference between CPT 11106 and 11107?

CPT 11106 is the primary code for the first incisional skin biopsy performed, while 11107 is the add-on code for each additional separate lesion biopsied during the same session. Always bill 11106 first, then add 11107 for each additional lesion.

Do you need a modifier when billing multiple units of 11107?

Modifiers are not required by CPT guidelines, but some payers may require modifier 59 or XS when billing multiple units of 11107 to demonstrate that each represents a distinct procedural service on separate lesions. Check individual payer policies for specific requirements.

What is the RVU value for CPT code 11107?

CPT 11107 has a total RVU of 2.1 for 2025, consisting of 0.54 work RVU, 1.5 non-facility PE RVU (0.31 facility PE RVU), and 0.06 malpractice RVU. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare payment rates.

Can you bill 11107 with shave biopsy or punch biopsy codes?

No, CPT 11107 is specifically for additional incisional biopsies and must be paired only with 11106. Shave biopsies use codes 11102-11103, and punch biopsies use 11104-11105. These represent different biopsy techniques and should not be mixed on the same claim for the same session.