CPT code 11105: Skin biopsy, each additional punch-biopsied lesion2026 Medicare rate & RVUs in Puerto Rico
Reports an additional punch biopsy of a distinct skin lesion during the same session as the first punch biopsy.
In Puerto Rico, Medicare pays $60.90 for 11105 in the office and $21.39 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 11105 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 11105 covers
This code represents a punch biopsy of an additional, separate skin lesion after the first lesion is biopsied by the punch method. A clinician uses a circular punch instrument to remove a tissue sample for diagnostic evaluation, commonly when assessing a suspicious lesion or skin change. Dermatologists and other clinicians who evaluate skin conditions may perform the procedure in an office or facility setting.
Report one unit for each additional distinct lesion biopsied by punch during the session; the first punch-biopsied lesion is represented by 11104. Documentation should identify the separate lesion sites and support why each required biopsy. This is an add-on code: report it only with the primary procedure, 11104, and payment is within that procedure's global period. It is not a standalone punch-biopsy service.
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 Puerto Rico compares for 11105
Across 109 of 109 payment localities, the office rate for 11105 runs from $53.20 in Arkansas to $80.18 in San Benito County, CA. Puerto Rico pays $60.90. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$60.90
- Los Angeles, CA · California$68.22+$7.32
- Washington, DC area · District of Columbia$69.24+$8.34
- Miami, FL · Florida$65.81+$4.91
- Chicago, IL · Illinois$63.80+$2.90
- Manhattan, NY · New York$69.80+$8.90
- Alaska · Alaska$69.58+$8.68
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $54.01 | $19.82 |
| ArkansasArkansas | $53.20 | $19.63 |
| ArizonaArizona | $58.77 | $20.91 |
| Bakersfield, CACalifornia | $63.99 | $21.16 |
| Chico, CACalifornia | $63.79 | $20.96 |
| El Centro, CACalifornia | $63.80 | $20.97 |
| Fresno, CACalifornia | $63.79 | $20.96 |
| Hanford, CACalifornia | $63.79 | $20.96 |
| Madera, CACalifornia | $63.79 | $20.96 |
| Merced, CACalifornia | $63.79 | $20.96 |
| Modesto, CACalifornia | $63.79 | $20.96 |
| Napa, CACalifornia | $74.04 | $22.53 |
| Oxnard, CACalifornia | $67.89 | $21.70 |
| Redding, CACalifornia | $63.79 | $20.96 |
| Rest of CaliforniaCalifornia | $63.79 | $20.96 |
| Riverside, CACalifornia | $64.54 | $21.71 |
| Sacramento, CACalifornia | $66.98 | $21.53 |
| Salinas, CACalifornia | $66.73 | $21.44 |
| San Diego, CACalifornia | $68.34 | $21.60 |
| Marin County, CACalifornia | $78.39 | $23.29 |
| San Francisco, CACalifornia | $78.31 | $23.21 |
| San Benito County, CACalifornia | $80.18 | $23.83 |
| Santa Clara County, CACalifornia | $79.85 | $23.50 |
| San Luis Obispo, CACalifornia | $65.66 | $21.15 |
| Santa Cruz, CACalifornia | $69.01 | $21.53 |
| Santa Maria, CACalifornia | $66.99 | $21.42 |
| Santa Rosa, CACalifornia | $69.71 | $21.72 |
| Stockton, CACalifornia | $63.79 | $20.96 |
| Vallejo, CACalifornia | $73.92 | $22.42 |
| Visalia, CACalifornia | $63.79 | $20.96 |
| Yuba City, CACalifornia | $63.79 | $20.96 |
| ColoradoColorado | $62.90 | $21.32 |
| ConnecticutConnecticut | $64.58 | $22.50 |
| DelawareDelaware | $59.77 | $21.16 |
| Fort Lauderdale, FLFlorida | $62.91 | $23.32 |
| Rest of FloridaFlorida | $59.72 | $22.36 |
| Atlanta, GAGeorgia | $61.66 | $21.96 |
| Rest of GeorgiaGeorgia | $56.22 | $21.36 |
| Hawaii, Guam, HIHawaii | $65.42 | $20.99 |
| IowaIowa | $55.35 | $19.60 |
| IdahoIdaho | $55.75 | $19.80 |
| East St. Louis, ILIllinois | $59.35 | $23.40 |
| Rest of IllinoisIllinois | $57.99 | $22.32 |
| Suburban Chicago, ILIllinois | $63.54 | $23.40 |
| IndianaIndiana | $56.08 | $19.86 |
| KansasKansas | $55.13 | $19.80 |
| KentuckyKentucky | $55.44 | $20.70 |
| New Orleans, LALouisiana | $58.21 | $21.44 |
| Rest of LouisianaLouisiana | $55.36 | $20.78 |
| Metropolitan Boston, MAMassachusetts | $69.22 | $22.56 |
| Rest of MassachusettsMassachusetts | $62.52 | $21.37 |
| Baltimore area, MDMaryland | $64.41 | $22.48 |
| Rest of MarylandMaryland | $60.93 | $21.38 |
| Rest of MaineMaine | $56.10 | $20.15 |
| Southern Maine, MEMaine | $59.20 | $20.47 |
| Detroit, MIMichigan | $60.54 | $22.83 |
| Rest of MichiganMichigan | $56.98 | $21.30 |
| MinnesotaMinnesota | $60.07 | $19.86 |
| Metropolitan Kansas City, MOMissouri | $57.75 | $21.06 |
| Metropolitan St. Louis, MOMissouri | $58.38 | $21.17 |
| Rest of MissouriMissouri | $54.40 | $20.72 |
| MississippiMississippi | $53.81 | $20.16 |
| MontanaMontana | $60.45 | $21.37 |
| North CarolinaNorth Carolina | $56.70 | $20.24 |
| North DakotaNorth Dakota | $59.07 | $19.99 |
| NebraskaNebraska | $55.66 | $19.59 |
| New HampshireNew Hampshire | $61.94 | $21.26 |
| Northern New JerseyNew Jersey | $68.49 | $23.16 |
| Rest of New JerseyNew Jersey | $65.27 | $22.59 |
| New MexicoNew Mexico | $57.32 | $21.49 |
| NevadaNevada | $60.11 | $20.99 |
| NYC suburbs and Long Island, NYNew York | $71.61 | $25.14 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $65.73 | $22.94 |
| Queens, NYNew York | $70.33 | $24.14 |
| Rest of New YorkNew York | $57.59 | $20.47 |
| OhioOhio | $56.70 | $21.02 |
| OklahomaOklahoma | $55.29 | $20.39 |
| Portland, OROregon | $64.91 | $21.50 |
| Rest of OregonOregon | $59.59 | $20.66 |
| Metropolitan Philadelphia, PAPennsylvania | $62.95 | $22.27 |
| Rest of PennsylvaniaPennsylvania | $56.77 | $20.89 |
| Rhode IslandRhode Island | $61.92 | $21.55 |
| South CarolinaSouth Carolina | $56.80 | $20.70 |
| South DakotaSouth Dakota | $58.90 | $19.82 |
| TennesseeTennessee | $55.42 | $19.90 |
| Austin, TXTexas | $62.74 | $21.39 |
| Beaumont, TXTexas | $56.38 | $20.82 |
| Brazoria, TXTexas | $59.67 | $20.94 |
| Dallas, TXTexas | $60.08 | $21.16 |
| Fort Worth, TXTexas | $59.68 | $21.15 |
| Galveston, TXTexas | $59.87 | $21.06 |
| Houston, TXTexas | $61.15 | $22.34 |
| Rest of TexasTexas | $58.01 | $20.93 |
| UtahUtah | $57.61 | $20.88 |
| VirginiaVirginia | $59.03 | $20.62 |
| Virgin Islands, VIUnited States Virgin Islands | $60.90 | $21.39 |
| VermontVermont | $58.87 | $20.18 |
| Rest of WashingtonWashington | $62.39 | $21.24 |
| King County, WAWashington | $70.62 | $22.67 |
| WisconsinWisconsin | $57.01 | $19.58 |
| West VirginiaWest Virginia | $55.78 | $21.82 |
| WyomingWyoming | $59.85 | $20.77 |
11105 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.
$53.20
$71.99
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 | $69.58 | 1 |
| AL | $54.01 | 1 |
| AR | $53.20 | 1 |
| AZ | $58.77 | 1 |
| CA | $63.79–$80.18 | 29 |
| CO | $62.90 | 1 |
| CT | $64.58 | 1 |
| DC | $69.24 | 1 |
| DE | $59.77 | 1 |
| FL | $59.72–$65.81 | 3 |
| GA | $56.22–$61.66 | 2 |
| GU | $65.42 | 1 |
| HI | $65.42 | 1 |
| IA | $55.35 | 1 |
| ID | $55.75 | 1 |
| IL | $57.99–$63.80 | 4 |
| IN | $56.08 | 1 |
| KS | $55.13 | 1 |
| KY | $55.44 | 1 |
| LA | $55.36–$58.21 | 2 |
| MA | $62.52–$69.22 | 2 |
| MD | $60.93–$69.24 | 3 |
| ME | $56.10–$59.20 | 2 |
| MI | $56.98–$60.54 | 2 |
| MN | $60.07 | 1 |
| MO | $54.40–$58.38 | 3 |
| MS | $53.81 | 1 |
| MT | $60.45 | 1 |
| NC | $56.70 | 1 |
| ND | $59.07 | 1 |
| NE | $55.66 | 1 |
| NH | $61.94 | 1 |
| NJ | $65.27–$68.49 | 2 |
| NM | $57.32 | 1 |
| NV | $60.11 | 1 |
| NY | $57.59–$71.61 | 5 |
| OH | $56.70 | 1 |
| OK | $55.29 | 1 |
| OR | $59.59–$64.91 | 2 |
| PA | $56.77–$62.95 | 2 |
| PR | $60.90 | 1 |
| RI | $61.92 | 1 |
| SC | $56.80 | 1 |
| SD | $58.90 | 1 |
| TN | $55.42 | 1 |
| TX | $56.38–$62.74 | 8 |
| UT | $57.61 | 1 |
| VA | $59.03–$69.24 | 2 |
| VI | $60.90 | 1 |
| VT | $58.87 | 1 |
| WA | $62.39–$70.62 | 2 |
| WI | $57.01 | 1 |
| WV | $55.78 | 1 |
| WY | $59.85 | 1 |
How the 11105 rate is calculated
Each of 11105’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 · 11105
RVUs × geographic indexes × conversion factor
Work0.44
0.44 RVUs× 1.000 GPCI
Practice expense1.30
1.30 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
1.8100
Conversion factor
$33.4009
Medicare rate
$60.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,273
- Code
- 11105
- Physician work
- 0.44
- Practice expense
- 1.30
- Malpractice
- 0.07
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.44 | × 1.000 | 0.4400 |
| Practice expense | 1.30 | × 1.011 | 1.3143 |
| Malpractice | 0.07 | × 0.985 | 0.0690 |
| Total RVUs | 1.8233 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$60.90
Office: (0.44 × 1 + 1.3 × 1.011 + 0.07 × 0.985) × $33.4009 = $60.90
Facility: (0.44 × 1 + 0.13 × 1.011 + 0.07 × 0.985) × $33.4009 = $21.39
Payment rules and modifiers for 11105
The CMS indicators that decide how 11105 is paid alongside other services.
CMS payment indicators · 11105
Skin biopsy, each additional punch-biopsied lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
How 11105 has changed in Puerto Rico
11105 · Office / nonfacility
$60.90
Effective 2026-10-01
The base rate is $3.07 higher than on 2025-10-01, moving from $57.83 to $60.90 (5.3%).
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
$57.83changed to$60.90
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.45 changed to 0.44
- Practice expense RVU 1.27 changed to 1.30
- Malpractice RVU 0.06 changed to 0.07
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$59.85changed to$57.83
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.28 changed to 1.27
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$58.87changed to$59.85
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$60.63changed to$58.87
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.27 changed to 1.28
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$60.32changed to$60.63
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$61.58changed to$60.32
- Conversion factor 34.6062 changed to 33.8872
- Malpractice RVU 0.05 changed to 0.06
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$62.79changed to$61.58
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.29 changed to 1.27
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$62.40changed to$62.79
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.22 changed to 1.29
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$62.63changed to$62.40
- Conversion factor 36.0391 changed to 36.0896
- Malpractice RVU 0.06 changed to 0.05
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$62.63
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 | $60.90 | $21.39 | RVU26D |
| 2026-07-01 | $60.90 | $21.39 | RVU26C |
| 2026-04-01 | $60.90 | $21.39 | RVU26B |
| 2026-01-01 | $60.90 | $21.39 | RVU26A |
| 2025-10-01 | $57.83 | $24.61 | RVU25D |
| 2025-07-01 | $57.83 | $24.61 | RVU25C |
| 2025-04-01 | $57.83 | $24.61 | RVU25B |
| 2025-01-01 | $57.83 | $24.61 | RVU25A |
| 2024-10-01 | $59.85 | $25.32 | RVU24D |
| 2024-07-01 | $59.85 | $25.32 | RVU24C |
| 2024-04-01 | $59.85 | $25.32 | RVU24B |
| 2024-03-09 | $59.85 | $25.32 | RVU24AR |
| 2024-01-01 | $58.87 | $24.91 | RVU24A |
| 2023-10-01 | $60.63 | $25.79 | RVU23D |
| 2023-07-01 | $60.32 | $25.75 | RVU23C |
| 2023-04-01 | $60.32 | $25.75 | RVU23B |
| 2023-01-01 | $60.32 | $25.75 | RVU23A |
| 2022-10-01 | $61.58 | $26.00 | RVU22D |
| 2022-07-01 | $61.58 | $26.00 | RVU22C |
| 2022-04-01 | $61.58 | $26.00 | RVU22B |
| 2022-01-01 | $61.58 | $26.00 | RVU22A |
| 2021-10-01 | $62.79 | $26.22 | RVU21D |
| 2021-07-01 | $62.79 | $26.22 | RVU21C |
| 2021-04-01 | $62.79 | $26.22 | RVU21B |
| 2021-01-01 | $62.79 | $26.22 | RVU21A |
| 2020-10-01 | $62.40 | $27.48 | RVU20D |
| 2020-07-01 | $62.40 | $27.48 | RVU20C |
| 2020-04-01 | $62.40 | $27.48 | RVU20B |
| 2020-01-01 | $62.40 | $27.48 | RVU20A |
| 2019-10-01 | $62.63 | $28.16 | RVU19D |
| 2019-07-01 | $62.63 | $28.16 | RVU19C |
| 2019-04-01 | $62.63 | $28.16 | RVU19B |
| 2019-01-01 | $62.63 | $28.16 | 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 Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
11105 billing questions
Which code reports the first punch-biopsied lesion?
Use 11104 for the first lesion. Code 11105 represents each additional, separate lesion biopsied by punch during the session.
Can 11105 be billed without 11104?
No. It is an add-on code and must be reported with 11104, the primary punch-biopsy code.
Does each punch sample require a unit of 11105?
Report a unit for each additional distinct lesion, not for multiple samples taken from the same lesion. Document the separate sites biopsied.
When should 11103 be used instead?
Use 11103 for each additional lesion sampled by the tangential method. Use 11105 when the additional lesion is biopsied with a punch.
How does the global-period rule affect 11105?
11105 is billed with 11104, and its payment is within the primary procedure's global period.
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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