CPT code 11104: Punch biopsy2026 Medicare rate & RVUs in Florida
A punch biopsy removes a cylindrical skin sample from one lesion for diagnostic examination when a core specimen is needed.
Medicare pays $118.75–$129.58 for 11104 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 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.
Where 11104 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$118.75 to $129.58
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $124.86 | $40.61 |
| Miami | $129.58 | $43.00 |
| Rest Of Florida | $118.75 | $39.24 |
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.
Payment rules and modifiers for 11104
The CMS indicators that decide how 11104 is paid alongside other services.
CMS payment indicators · 11104
Punch biopsy
| 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
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%).
11104 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 11105Skin biopsy
- Use 11105 for each additional separate lesion sampled by punch after the first; 11104 represents the first punch-biopsied lesion.
- 11102Tangential skin biopsy
- Use 11102 when the clinician samples a lesion tangentially rather than removing a cylindrical core with a punch.
- 11106Skin biopsy
- Use 11106 when tissue is sampled by an incision rather than with a punch instrument.
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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