| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $92.37 |
| Typical Billed Amount What providers commonly charge | $120 – $450 |
| Potential Markup How much more you might pay vs. Medicare rate | 387% above Medicare |
What CPT 11104 Means and When It's Used
CPT code 11104 represents a punch biopsy of a single skin lesion. During this procedure, your dermatologist uses a small, circular tool (like a tiny cookie cutter) to remove a small piece of skin tissue for laboratory testing. This is one of the most common ways doctors diagnose skin conditions, including skin cancer.
Your doctor will use this code when they need to examine suspicious moles, unusual growths, rashes that won't heal, or any skin changes that need further investigation. The procedure typically takes just a few minutes and is done in the doctor's office under local anesthesia.
It's important to note that this code covers only one lesion. If your doctor biopsies multiple spots during the same visit, you may see additional codes on your bill, such as CPT 11102 or 11106 for additional lesions.
Understanding the Costs and Your Bill
For CPT code 11104, you can expect to see charges ranging from $120 to $450 on your medical bill. The exact amount depends on your location, the healthcare facility, and your doctor's pricing. Medicare reimburses this procedure at $92.37, which gives you an idea of the baseline cost.
On your bill or explanation of benefits, you'll see this listed as 'punch biopsy of skin' or similar wording, along with the CPT code 11104. The charge covers the actual biopsy procedure but doesn't include the laboratory analysis of the tissue sample, which will appear as a separate charge with a different code.
If you have insurance, your out-of-pocket cost will depend on whether you've met your deductible and your plan's coverage for diagnostic procedures. Many insurance plans cover medically necessary biopsies at a high percentage once you meet your deductible.
How to Verify Your Bill Is Correct
To check if you were billed correctly for CPT 11104, first confirm that you actually had a punch biopsy performed during your visit. Look at your medical records or visit summary to verify that one lesion was biopsied using the punch technique. If multiple lesions were biopsied, you should see additional codes on your bill.
Compare the charge amount to the typical range of $120-$450. If your bill is significantly higher than $450, contact your doctor's billing office to ask for an explanation. Sometimes errors occur, such as billing for multiple lesions when only one was biopsied, or using a more expensive procedure code by mistake.
If you believe there's an error, gather your medical records from the visit and contact the billing department. Ask them to review the procedure notes and explain the charges. Most billing errors can be resolved quickly once identified. If you're still unsure, you can also contact your insurance company to help review the claim.