CPT code 11104: Punch biopsy, single skin lesion2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $139.28 for 11104 in the office and $41.30 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 11104 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 11104 covers

A punch biopsy uses a circular cutting instrument to obtain a cylindrical sample of skin from one lesion for diagnostic evaluation. Dermatologists and other clinicians may perform it in an office or facility setting, commonly when evaluating a suspicious growth or a skin condition that requires tissue examination. Simple closure, when performed, is included in the procedure.

Choose this code for one lesion sampled by the punch technique; the method, rather than the lesion’s diagnosis or size, distinguishes it from tangential or incisional biopsy codes. For additional separate lesions sampled by punch during the same session, report 11105. Document the sampled site, punch technique, number of lesions, and reason for the biopsy. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, CMS pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate; assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 11104

Across 109 of 109 payment localities, the office rate for 11104 runs from $106.93 in Arkansas to $163.13 in San Benito County, CA. Washington, DC area pays $139.28. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

11104 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 11104 in every payment locality

How the 11104 rate is calculated

Each of 11104’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 11104

The CMS indicators that decide how 11104 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 11104

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 11104 has changed in Washington, DC area

Price 11104 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

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Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates