Add-on code for each additional skin lesion sampled by tangential biopsy at the same visit as a primary biopsy.
- Medicare
- $48.77
- Work RVU
- 0.37
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Each additional lesion location and size
- Technique used on each lesion
- Separate pathology specimen per lesion
- Primary biopsy code performed the same day
- Clinical reason for each biopsy
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
11103 is the add-on for each additional separate lesion biopsied with a tangential technique (shave, scoop, saucerize, curette). It is never billed alone and has a ZZZ global, meaning it follows the primary code.
In a podiatry or hand practice, this shows up when two or three suspicious lesions are sampled at one visit. 11103 can be paired with 11102, and also with the punch (11104) or incisional (11106) primary codes, because only one primary biopsy code is allowed per encounter.
Units matter. One unit of 11103 per additional lesion. A second sample from the same lesion is not another unit. Each lesion should have its own pathology container and its own description in the note. Some payers want 59 or XS, and anatomic modifiers on the add-on to show that the lesions are distinct. Denials usually come from billing 11103 without a primary on the claim.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.37) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.46) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.37 |
| Practice expense RVU | 1.05 |
| Malpractice RVU | 0.04 |
| Total RVU | 1.46 |
| Medicare national rate | $48.77 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $48.77 |
Common denial reasons
The recurring reasons claims for CPT 11103 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed without a primary biopsy code
- Two samples from one lesion billed as two units
- Lesion sites not distinguished in the note
- Missing distinct-site modifier for payers that require it
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 11103 be billed alone?
02Can 11103 go with a punch biopsy?
03How many units of 11103 can I bill?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe lists each lesion biopsied with its own location and specimen, so add-on units match the note.
See how Mira captures CPT 11103 documentation