Dermatology Billing & Coding Guide
Lesion destruction sizing, biopsy 11102-11107 vs 17000-17004, MOHS staged excision.
Common Dermatology CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 11102 | Tangntl bx skin single les | 0.64 | 2.86 | 000 |
| 11103 | Tangntl bx skin ea sep/addl | 0.37 | 1.46 | ZZZ |
| 11104 | Punch bx skin single lesion | 0.81 | 3.63 | 000 |
| 11105 | Punch bx skin ea sep/addl | 0.44 | 1.81 | ZZZ |
| 11106 | Incal bx skn single les | 0.98 | 4.53 | 000 |
| 11107 | Incal bx skn ea sep/addl | 0.53 | 2.12 | ZZZ |
| 17110 | Destruction b9 les up to 14 | 0.68 | 3.33 | 010 |
| 17111 | Destruction b9 lesions 15/> | 0.95 | 3.89 | 010 |
| 17000 | Destruct premalg lesion | 0.59 | 1.99 | 010 |
| 17003 | Destruct premalg les 2-14 | 0.04 | 0.19 | ZZZ |
| 17004 | Destroy premal lesions 15/> | 1.34 | 4.86 | 010 |
| 17311 | Mohs 1 stage h/n/hf/g | 6.05 | 19.97 | 000 |
| 17312 | Mohs addl stage | 3.22 | 12.06 | ZZZ |
| 17313 | Mohs 1 stage t/a/l | 5.42 | 18.75 | 000 |
| 17314 | Mohs addl stage t/a/l | 2.98 | 11.54 | ZZZ |
| 11310 | Shave skin lesion 0.5 cm/< | 0.78 | 3.34 | 000 |
| 11311 | Shave skin lesion 0.6-1.0 cm | 1.07 | 3.96 | 000 |
| 11312 | Shave skin lesion 1.1-2.0 cm | 1.27 | 4.51 | 000 |
| 11313 | Shave skin lesion >2.0 cm | 1.64 | 5.29 | 000 |
| 11400 | Exc tr-ext b9+marg 0.5 cm< | 0.88 | 3.83 | 010 |
What Dermatology practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
Biopsy code selection: 2021 biopsy code changes created 3 types — tangential (11102/11103), punch (11104/11105), incisional (11106/11107). Punch biopsy pays $20-30 MORE than tangential. Select the correct type based on technique used.
Destruction code stacking: 17000 (first premalignant) + 17003 (each 2-14) + 17004 (15+). A patient with 25 actinic keratoses = 17000 + 17003x13 + 17004 = $250-350.
Closure code optimization: Simple closure is included in the excision code. But intermediate closure (12031-12057) and complex closure (13100-13160) are separately billable. Many practices miss the repair code.
Mohs add-on stages: Each additional Mohs stage adds $120-180. Proper documentation ensures every stage is billable. Average Mohs case = 1.8 stages.
E/M with multiple procedures: When a patient presents for a skin check AND has procedures, bill E/M (99213-25) + procedure codes. The skin check itself is a separately identifiable E/M.
Phototherapy (96910-96913): Each session is separately billable. NB-UVB (96912) pays more than targeted (96910). Documenting body surface area treated determines code selection.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Dermatology. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
11102 is first biopsy, 11103 is each additional. NEVER bill 11103 without 11102. Count: 3 biopsies = 11102 + 11103 + 11103.
Tangential (11102) and incisional (11106) biopsy on same date: bill the appropriate technique for each site. Different techniques at different sites are separately billable.
17000 is first premalignant lesion, 17003 is 2nd-14th, 17004 is 15+. Example: 8 lesions = 17000 + 17003x7. 20 lesions = 17000 + 17003x13 + 17004.
17110 is first 14 benign lesions, 17111 is each additional 15. Example: 30 lesions = 17110 + 17111.
Biopsy + excision at SAME site: if biopsy is taken and then excised in same session, bill only the excision. Biopsy is included.
Excision + intermediate closure: excision code includes simple closure. If intermediate or complex closure is needed, bill repair code separately.
Modifier Guidance for Dermatology
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Required for additional biopsy sites. If doing 3 biopsies at 3 sites: 11102 + 11103-59 + 11103-59. Each must have a different anatomic location documented.
E/M with biopsy/destruction: if an E/M is separately identifiable (evaluated lesion AND a separate problem), add modifier 25. Don't use 25 if the only reason for the visit is the biopsy.
Staged procedure — Mohs surgery followed by reconstruction at a later date during the global period. Bill reconstruction with modifier 58.
Repeat procedure — same day, same physician. Uncommon in derm but used for re-excision with positive margins.
Decision for surgery — E/M where the decision to perform a major surgery (90-day global) is made. Common with melanoma diagnosis leading to wide local excision.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Biopsy: Document lesion description (size, shape, color, borders), anatomic location (specific — 'left forearm, 5cm distal to antecubital fossa'), indication (why biopsied), and technique used (shave/punch/incisional).
- Excision: Document pre-excision lesion size in cm, excision margins, wound dimensions (length x width before closure), closure type (simple/intermediate/complex), and pathology requisition.
- Destruction: Document number of lesions, size of each, location of each, method of destruction (cryotherapy/electrodesiccation/laser), and indication (pre-malignant vs benign).
- Mohs: Document each stage: tissue excised, mapping, histologic exam findings, positive margins requiring additional stage. Final stage must document clear margins.
OIG and audit triggers in Dermatology
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
Wrong biopsy code type: Shave = tangential (11102). Punch = punch (11104). Using the wrong code = CARC 4 denial. The technique must match the code.
Biopsy + excision same site: If you biopsy and then excise a lesion in the same session, bill ONLY the excision. The biopsy is included. Only bill separately if biopsy and excision are at DIFFERENT sites.
Closure code missed: Intermediate and complex closures are separately billable on top of the excision code. Many practices only bill the excision and leave $50-200 on the table.
Pre-malignant vs benign destruction: 17000/17003/17004 = pre-malignant (actinic keratoses). 17110/17111 = benign (warts, seborrheic keratoses). Using the wrong series = denial.
Excision size: Bill based on excised specimen size (diameter), NOT the lesion size. A 0.5cm lesion with 0.4cm margins = 1.3cm excision. This often bumps to a higher code tier.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Dermatology.
ME Medicare +
Mohs surgery requires real-time pathology interpretation by the surgeon. Medicare pays well for Mohs ($200-300/stage). Phototherapy: 30-36 sessions covered, then requires reauthorization. Cosmetic procedures never covered.
UN UnitedHealthcare +
Requires path report for all excisions. Pre-auth for Mohs on trunk/extremities (not face). Limits destructions to 15/visit without prior approval.
AE Aetna +
Covers Mohs for specific diagnoses (BCC, SCC in specific locations). Requires documentation of Mohs appropriateness criteria. Limits biopsies to reasonable number per visit.
BC BCBS +
Varies by state plan. Some require pre-auth for Mohs. Most cover phototherapy with documented diagnosis (psoriasis, vitiligo). Cosmetic exclusions apply.
Standard Dermatology coding workflow
1. Count and document all lesions by type (pre-malignant vs benign vs suspicious). 2. Select biopsy technique code (tangential/punch/incisional). 3. For destructions: count lesions, select 17000/17003/17004 (premalignant) or 17110/17111 (benign). 4. For excisions: measure excised specimen size (not lesion size), select code by size and location. 5. Add closure code if intermediate or complex. 6. Apply modifier 59/XS for different anatomic sites. 7. If separate E/M performed, add modifier 25. 8. Match ICD-10: use D-codes for neoplasm uncertain behavior, L-codes for benign conditions, Z-codes for screening.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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