CPT code 11104: Punch biopsy, single skin lesion2026 Medicare rate & RVUs in Houston, TX
A punch biopsy removes a cylindrical skin sample from one lesion for diagnostic examination when a core specimen is needed.
In Houston, TX, Medicare pays $121.95 for 11104 in the office and $39.37 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.
On this page 11 sections
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 Houston, TX 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. Houston, TX pays $121.95. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Houston, TX · this page$121.95
- Austin, TX · Texas$126.25+$4.30
- Beaumont, TX · Texas$112.83−$9.12
- Brazoria, TX · Texas$119.98−$1.97
- Dallas, TX · Texas$120.70−$1.25
- Fort Worth, TX · Texas$119.82−$2.13
- Galveston, TX · Texas$120.31−$1.64
Other areas in Texas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Rest of TexasTexas | $116.30 | $37.38 |
| Los Angeles, CACalifornia | $138.03 | $39.64 |
| Washington, DC areaDistrict of Columbia | $139.28 | $41.30 |
| Miami, FLFlorida | $129.58 | $43.00 |
| Chicago, ILIllinois | $125.78 | $42.20 |
| Manhattan, NYNew York | $139.51 | $42.87 |
| AlaskaAlaska | $139.35 | $50.78 |
| AlabamaAlabama | $108.54 | $35.77 |
| ArkansasArkansas | $106.93 | $35.49 |
| ArizonaArizona | $117.99 | $37.40 |
| Bakersfield, CACalifornia | $129.34 | $38.19 |
| Chico, CACalifornia | $129.06 | $37.91 |
| El Centro, CACalifornia | $129.08 | $37.93 |
| Fresno, CACalifornia | $129.06 | $37.91 |
| Hanford, CACalifornia | $129.06 | $37.91 |
| Madera, CACalifornia | $129.06 | $37.91 |
| Merced, CACalifornia | $129.06 | $37.91 |
| Modesto, CACalifornia | $129.06 | $37.91 |
| Napa, CACalifornia | $150.47 | $40.85 |
| Oxnard, CACalifornia | $137.47 | $39.16 |
| Redding, CACalifornia | $129.06 | $37.91 |
| Rest of CaliforniaCalifornia | $129.06 | $37.91 |
| Riverside, CACalifornia | $130.04 | $38.89 |
| Sacramento, CACalifornia | $135.69 | $38.96 |
| Salinas, CACalifornia | $135.19 | $38.80 |
| San Diego, CACalifornia | $138.55 | $39.08 |
| Marin County, CACalifornia | $159.57 | $42.31 |
| San Francisco, CACalifornia | $159.47 | $42.21 |
| San Benito County, CACalifornia | $163.13 | $43.20 |
| Santa Clara County, CACalifornia | $162.71 | $42.78 |
| San Luis Obispo, CACalifornia | $132.99 | $38.26 |
| Santa Cruz, CACalifornia | $140.02 | $38.97 |
| Santa Maria, CACalifornia | $135.74 | $38.77 |
| Santa Rosa, CACalifornia | $141.45 | $39.32 |
| Stockton, CACalifornia | $129.06 | $37.91 |
| Vallejo, CACalifornia | $150.32 | $40.70 |
| Visalia, CACalifornia | $129.06 | $37.91 |
| Yuba City, CACalifornia | $129.06 | $37.91 |
| ColoradoColorado | $126.75 | $38.26 |
| ConnecticutConnecticut | $129.44 | $39.87 |
| DelawareDelaware | $119.98 | $37.81 |
| Fort Lauderdale, FLFlorida | $124.86 | $40.61 |
| Rest of FloridaFlorida | $118.75 | $39.24 |
| Atlanta, GAGeorgia | $123.39 | $38.89 |
| Rest of GeorgiaGeorgia | $111.97 | $37.79 |
| Hawaii, Guam, HIHawaii | $132.47 | $37.91 |
| IowaIowa | $111.68 | $35.58 |
| IdahoIdaho | $112.37 | $35.85 |
| East St. Louis, ILIllinois | $117.00 | $40.48 |
| Rest of IllinoisIllinois | $115.00 | $39.07 |
| Suburban Chicago, ILIllinois | $126.22 | $40.80 |
| IndianaIndiana | $113.04 | $35.95 |
| KansasKansas | $111.00 | $35.82 |
| KentuckyKentucky | $110.87 | $36.93 |
| New Orleans, LALouisiana | $116.27 | $38.01 |
| Rest of LouisianaLouisiana | $110.63 | $37.03 |
| Metropolitan Boston, MAMassachusetts | $139.71 | $40.41 |
| Rest of MassachusettsMassachusetts | $125.90 | $38.32 |
| Baltimore area, MDMaryland | $129.05 | $39.81 |
| Rest of MarylandMaryland | $122.36 | $38.20 |
| Rest of MaineMaine | $112.81 | $36.30 |
| Southern Maine, MEMaine | $119.32 | $36.90 |
| Detroit, MIMichigan | $120.12 | $39.86 |
| Rest of MichiganMichigan | $113.70 | $37.77 |
| MinnesotaMinnesota | $121.77 | $36.19 |
| Metropolitan Kansas City, MOMissouri | $115.61 | $37.52 |
| Metropolitan St. Louis, MOMissouri | $116.87 | $37.70 |
| Rest of MissouriMissouri | $108.58 | $36.89 |
| MississippiMississippi | $107.79 | $36.18 |
| MontanaMontana | $121.24 | $38.07 |
| North CarolinaNorth Carolina | $114.05 | $36.45 |
| North DakotaNorth Dakota | $119.46 | $36.29 |
| NebraskaNebraska | $112.35 | $35.59 |
| New HampshireNew Hampshire | $124.61 | $38.03 |
| Northern New JerseyNew Jersey | $137.74 | $41.27 |
| Rest of New JerseyNew Jersey | $131.01 | $40.19 |
| New MexicoNew Mexico | $114.28 | $38.02 |
| NevadaNevada | $120.83 | $37.58 |
| NYC suburbs and Long Island, NYNew York | $142.79 | $43.90 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $131.76 | $40.69 |
| Queens, NYNew York | $140.90 | $42.60 |
| Rest of New YorkNew York | $115.79 | $36.78 |
| OhioOhio | $113.34 | $37.40 |
| OklahomaOklahoma | $110.82 | $36.55 |
| Portland, OROregon | $131.03 | $38.63 |
| Rest of OregonOregon | $119.99 | $37.15 |
| Metropolitan Philadelphia, PAPennsylvania | $126.05 | $39.47 |
| Rest of PennsylvaniaPennsylvania | $113.60 | $37.25 |
| Puerto RicoPuerto Rico | $122.20 | $38.12 |
| Rhode IslandRhode Island | $124.44 | $38.53 |
| South CarolinaSouth Carolina | $113.86 | $37.02 |
| South DakotaSouth Dakota | $119.25 | $36.08 |
| TennesseeTennessee | $111.56 | $35.96 |
| UtahUtah | $115.47 | $37.29 |
| VirginiaVirginia | $118.81 | $37.06 |
| Virgin Islands, VIUnited States Virgin Islands | $122.20 | $38.12 |
| VermontVermont | $118.85 | $36.51 |
| Rest of WashingtonWashington | $125.71 | $38.14 |
| King County, WAWashington | $142.75 | $40.70 |
| WisconsinWisconsin | $115.34 | $35.66 |
| West VirginiaWest Virginia | $110.60 | $38.32 |
| WyomingWyoming | $120.46 | $37.30 |
11104 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$106.93
$146.10
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $139.35 | 1 |
| AL | $108.54 | 1 |
| AR | $106.93 | 1 |
| AZ | $117.99 | 1 |
| CA | $129.06–$163.13 | 29 |
| CO | $126.75 | 1 |
| CT | $129.44 | 1 |
| DC | $139.28 | 1 |
| DE | $119.98 | 1 |
| FL | $118.75–$129.58 | 3 |
| GA | $111.97–$123.39 | 2 |
| GU | $132.47 | 1 |
| HI | $132.47 | 1 |
| IA | $111.68 | 1 |
| ID | $112.37 | 1 |
| IL | $115.00–$126.22 | 4 |
| IN | $113.04 | 1 |
| KS | $111.00 | 1 |
| KY | $110.87 | 1 |
| LA | $110.63–$116.27 | 2 |
| MA | $125.90–$139.71 | 2 |
| MD | $122.36–$139.28 | 3 |
| ME | $112.81–$119.32 | 2 |
| MI | $113.70–$120.12 | 2 |
| MN | $121.77 | 1 |
| MO | $108.58–$116.87 | 3 |
| MS | $107.79 | 1 |
| MT | $121.24 | 1 |
| NC | $114.05 | 1 |
| ND | $119.46 | 1 |
| NE | $112.35 | 1 |
| NH | $124.61 | 1 |
| NJ | $131.01–$137.74 | 2 |
| NM | $114.28 | 1 |
| NV | $120.83 | 1 |
| NY | $115.79–$142.79 | 5 |
| OH | $113.34 | 1 |
| OK | $110.82 | 1 |
| OR | $119.99–$131.03 | 2 |
| PA | $113.60–$126.05 | 2 |
| PR | $122.20 | 1 |
| RI | $124.44 | 1 |
| SC | $113.86 | 1 |
| SD | $119.25 | 1 |
| TN | $111.56 | 1 |
| TX | $112.83–$126.25 | 8 |
| UT | $115.47 | 1 |
| VA | $118.81–$139.28 | 2 |
| VI | $122.20 | 1 |
| VT | $118.85 | 1 |
| WA | $125.71–$142.75 | 2 |
| WI | $115.34 | 1 |
| WV | $110.60 | 1 |
| WY | $120.46 | 1 |
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.
How the rate is built · 11104
RVUs × geographic indexes × conversion factor
Work0.81
0.81 RVUs× 1.000 GPCI
Practice expense2.73
2.73 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
3.6300
Conversion factor
$33.4009
Medicare rate
$121.25
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Houston, TX inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,272
- Code
- 11104
- Physician work
- 0.81
- Practice expense
- 2.73
- Malpractice
- 0.09
GPCI2026.csv
102
- Locality
- Houston, TX
- Physician work
- 1.008
- Practice expense
- 0.993
- Malpractice
- 1.376
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.81 | × 1.008 | 0.8165 |
| Practice expense | 2.73 | × 0.993 | 2.7109 |
| Malpractice | 0.09 | × 1.376 | 0.1238 |
| Total RVUs | 3.6512 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Houston, TX$121.95
Office: (0.81 × 1.008 + 2.73 × 0.993 + 0.09 × 1.376) × $33.4009 = $121.95
Facility: (0.81 × 1.008 + 0.24 × 0.993 + 0.09 × 1.376) × $33.4009 = $39.37
Payment rules and modifiers for 11104
The CMS indicators that decide how 11104 is paid alongside other services.
CMS payment indicators · 11104
Punch biopsy, single skin lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11104 without 51 · national office
$121.25
Punch biopsy, single skin lesion
11104-51 · Second procedure: 50%
$60.63
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 11104 has changed in Houston, TX
11104 · Office / nonfacility
$121.95
Effective 2026-10-01
The base rate is $0.62 higher than on 2025-10-01, moving from $121.33 to $121.95 (0.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$121.33changed to$121.95
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.83 changed to 0.81
- Practice expense RVU 2.76 changed to 2.73
- Malpractice RVU 0.10 changed to 0.09
- Work GPCI 1.014 changed to 1.008
- Practice expense GPCI 1.003 changed to 0.993
- Malpractice GPCI 1.409 changed to 1.376
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$127.19changed to$121.33
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.83 changed to 2.76
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$125.12changed to$127.19
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$130.81changed to$125.12
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.85 changed to 2.83
- Work GPCI 1.023 changed to 1.014
- Practice expense GPCI 1.016 changed to 1.003
- Malpractice GPCI 1.154 changed to 1.409
January 1, 2023
RVU23A
$134.65changed to$130.81
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.87 changed to 2.85
- Malpractice RVU 0.09 changed to 0.10
- Work GPCI 1.032 changed to 1.023
- Practice expense GPCI 1.029 changed to 1.016
- Malpractice GPCI 0.900 changed to 1.154
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$136.84changed to$134.65
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.90 changed to 2.87
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$131.27changed to$136.84
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.65 changed to 2.90
- Work GPCI 1.026 changed to 1.032
- Practice expense GPCI 1.020 changed to 1.029
- Malpractice GPCI 0.918 changed to 0.900
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$128.32changed to$131.27
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.58 changed to 2.65
- Malpractice RVU 0.11 changed to 0.09
- Work GPCI 1.020 changed to 1.026
- Practice expense GPCI 1.012 changed to 1.020
- Malpractice GPCI 0.936 changed to 0.918
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$128.32
Held through RVU19B, RVU19C, RVU19D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $121.95 | $39.37 | RVU26D |
| 2026-07-01 | $121.95 | $39.37 | RVU26C |
| 2026-04-01 | $121.95 | $39.37 | RVU26B |
| 2026-01-01 | $121.95 | $39.37 | RVU26A |
| 2025-10-01 | $121.33 | $47.03 | RVU25D |
| 2025-07-01 | $121.33 | $47.03 | RVU25C |
| 2025-04-01 | $121.33 | $47.03 | RVU25B |
| 2025-01-01 | $121.33 | $47.03 | RVU25A |
| 2024-10-01 | $127.19 | $48.06 | RVU24D |
| 2024-07-01 | $127.19 | $48.06 | RVU24C |
| 2024-04-01 | $127.19 | $48.06 | RVU24B |
| 2024-03-09 | $127.19 | $48.06 | RVU24AR |
| 2024-01-01 | $125.12 | $47.28 | RVU24A |
| 2023-10-01 | $130.81 | $48.52 | RVU23D |
| 2023-07-01 | $130.81 | $48.52 | RVU23C |
| 2023-04-01 | $130.81 | $48.52 | RVU23B |
| 2023-01-01 | $130.81 | $48.52 | RVU23A |
| 2022-10-01 | $134.65 | $48.47 | RVU22D |
| 2022-07-01 | $134.65 | $48.47 | RVU22C |
| 2022-04-01 | $134.65 | $48.47 | RVU22B |
| 2022-01-01 | $134.65 | $48.47 | RVU22A |
| 2021-10-01 | $136.84 | $49.23 | RVU21D |
| 2021-07-01 | $136.84 | $49.23 | RVU21C |
| 2021-04-01 | $136.84 | $49.23 | RVU21B |
| 2021-01-01 | $136.84 | $49.23 | RVU21A |
| 2020-10-01 | $131.27 | $51.38 | RVU20D |
| 2020-07-01 | $131.27 | $51.38 | RVU20C |
| 2020-04-01 | $131.27 | $51.38 | RVU20B |
| 2020-01-01 | $131.27 | $51.38 | RVU20A |
| 2019-10-01 | $128.32 | $52.09 | RVU19D |
| 2019-07-01 | $128.32 | $52.09 | RVU19C |
| 2019-04-01 | $128.32 | $52.09 | RVU19B |
| 2019-01-01 | $128.32 | $52.09 | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Houston, TX rate applies
Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.
- 11104 in Houston · multiple payment areas
- Aldine
- Atascocita
- Barrett
- 11104 in Baytown · multiple payment areas
- Bellaire
- Bunker Hill Village
- Channelview
11104 billing questions
When should I choose 11104 instead of 11102 or 11106?
Use 11104 when the clinician takes a cylindrical core with a punch instrument. Code 11102 is for tangential sampling, while 11106 is for incisional sampling.
How are additional punch-biopsied lesions reported?
Report 11104 for the first lesion and 11105 for each additional separate lesion sampled by punch in the same session.
Is simple closure separately reported?
Simple closure performed as part of the punch biopsy is included in the service.
Does modifier 50 apply to punch biopsies on both sides of the body?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports 11104?
Record the biopsy technique, the lesion’s location, the number of sampled lesions, and the clinical reason for obtaining tissue.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure.
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
Show the CMS file lines behind this rate
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