| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $80.91 |
| Typical Billed Amount What providers commonly charge | $100 – $400 |
| Potential Markup How much more you might pay vs. Medicare rate | 394% above Medicare |
What CPT Code 11102 Means
CPT code 11102 describes a "tangential biopsy of skin, single lesion," which is commonly known as a shave biopsy. This procedure involves your doctor using a small blade or razor to remove a thin, horizontal slice of skin tissue from a suspicious mole, growth, or other skin lesion.
Your dermatologist typically uses this method when they need to examine skin cells under a microscope to check for cancer, infections, or other skin conditions. The procedure is quick, usually taking just a few minutes, and is performed in the doctor's office with local anesthesia to numb the area.
This code applies only when one lesion is biopsied. If your doctor takes samples from multiple spots during the same visit, you'll see additional codes on your bill for each additional biopsy performed.
How CPT 11102 Billing Works
When you receive your medical bill or explanation of benefits, you'll see CPT code 11102 listed for your skin biopsy. The Medicare reimbursement rate for this procedure is $80.91, but most healthcare providers charge between $100 and $400 for this service.
Your actual out-of-pocket cost depends on your insurance coverage, deductible, and whether you've met your annual deductible. If you have Medicare, you'll typically pay 20% of the Medicare-approved amount after meeting your deductible. Private insurance plans vary, but many cover dermatology biopsies as medically necessary procedures.
The bill should clearly show one unit of CPT 11102 for each single lesion that was biopsied. You may also see separate charges for the pathology lab work (analyzing the tissue sample), which uses different billing codes and is often billed separately by the laboratory.
Checking Your Bill for Accuracy
To verify your CPT 11102 billing is correct, first confirm that the number of units matches the number of lesions your doctor actually biopsied. If only one spot was sampled, you should see exactly one unit of code 11102. Multiple biopsies should show additional codes like 11104 or 11106 for each extra lesion.
Check that the charge falls within the typical range of $100-$400. If you see a charge significantly higher than $400, contact your healthcare provider's billing department to ask for an itemized explanation. Sometimes errors occur, such as billing for multiple procedures when only one was performed.
If you believe there's an error, gather your visit notes or discharge summary that describes what procedures were actually done. Contact your provider's billing office first, as they can often resolve simple mistakes quickly. If the issue isn't resolved, you can also contact your insurance company to request a review of the claim.