CPT 11102

Skin Biopsy, Tangential (Shave), First Lesion

CPT 11102 covers a tangential (shave) biopsy of the first skin lesion, performed over 2.6 million times per year. Providers charge an average of $222.64 for this procedure, but Medicare pays only $95.53 in an office setting (2.3x markup). What most patients do not realize: the biopsy itself is just step one. A separate pathology bill (CPT 88305, averaging about $182) always follows to analyze the tissue sample, pushing the true cost above $400 per lesion.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 11102 at a Glance

Average provider charge: $222.64
Medicare rate (office): $95.53
Medicare rate (facility): $30.06
Typical markup: 2.3x over Medicare office rate

Procedure: Tangential (shave) biopsy, first lesion
Hidden cost: Pathology (88305) adds ~$182
True total cost: $400+ per lesion
Beneficiaries (2023): 2.6 million

How the Medicare Rate Is Calculated

Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for CPT 11102:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time, skill, and judgment	0.64	0.64
Practice Expense RVU	Rent, staff, equipment, supplies	2.16	0.20
Malpractice RVU	Professional liability insurance	0.06	0.06
Total RVU		2.86	0.90
x $33.4009	2026 conversion factor	$95.53	$30.06

The hidden second bill: The $95.53 Medicare rate (or the $222.64 average charge) covers only the biopsy procedure itself. A separate pathology charge under CPT 88305 (averaging about $182) is always billed to analyze the tissue sample. This means the true cost of a single skin biopsy is $400 or more. If multiple lesions are biopsied, each one generates its own biopsy code (11102/11103) plus its own 88305 pathology charge.

Medicare Rate by State

Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). The same shave biopsy pays differently depending on your location, ranging from about $66 in Arkansas to $96 in Alaska (a 46% spread).

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$76.05	$222.64	2.9x
California (Los Angeles)	$82.79	$222.64	2.7x
New York (Manhattan)	$83.00	$222.64	2.7x
Florida (Fort Lauderdale)	$77.72	$222.64	2.9x
Ohio	$70.02	$222.64	3.2x
Mississippi	$66.89	$222.64	3.3x
Arkansas	$66.05	$222.64	3.4x
Alaska	$96.42	$222.64	2.3x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $222.64 is the 2023 national average from CMS utilization data. Actual charges vary by provider. These rates do not include the separate pathology charge.

What Insured Patients Actually Pay for a Skin Biopsy

If you have health insurance, your cost depends on your plan design. Keep in mind that the biopsy (11102) and the pathology (88305) are billed separately, often by different providers. You will receive two Explanations of Benefits (EOBs) and potentially two bills.

Your Situation	Biopsy Cost to You	How It Works
Copay plan (deductible met or N/A)	$30 to $75	Specialist copay for the dermatologist visit (pathology bill separate)
Coinsurance plan (deductible met)	$25 to $55	20% of negotiated rate for biopsy (plus 20% of pathology separately)
High-deductible plan (deductible NOT met)	$120 to $275	Full negotiated rate for biopsy, plus full negotiated rate for pathology
Medicare Part B	$19.11	20% of $95.53 (plus 20% of pathology fee separately)
Medicaid	$0 to $5	Minimal or no cost-sharing in most states

Ask before the biopsy: "How many specimens will be sent, and is the pathology lab in my network?" The pathologist who reads your biopsy is often a separate provider. Even at an in-network dermatologist's office, the pathology lab may be out-of-network, leaving you responsible for a larger share of the pathology bill.

Should You Use Insurance or Pay Cash?

For skin biopsies, the insurance vs. cash decision is more complex because two separate charges are involved. Some dermatologists offer a bundled cash-pay price of $150 to $250 that includes the biopsy and basic pathology. If your deductible is not met, this can be significantly cheaper than the combined insurance-negotiated rates for 11102 + 88305.

When Cash-Pay Wins

Your deductible is not met and is unlikely to be met this year
The dermatologist offers a bundled cash rate for biopsy + pathology
The pathology lab is out-of-network under your plan
You only need a single lesion biopsied

When Using Insurance Wins

You are close to meeting your deductible
Multiple lesions need biopsy (costs add up quickly)
Both the dermatologist and pathology lab are in-network
You expect follow-up treatment (excision, Mohs surgery) if results are abnormal

Important consideration: If the biopsy results come back abnormal (skin cancer, precancer), you will likely need additional procedures such as excision (CPT 11600 series) or Mohs surgery (CPT 17311 series). These are expensive and will count toward your deductible. If there is a reasonable chance your biopsy could lead to further treatment, running the initial biopsy through insurance to build toward your deductible may be the smarter financial choice.

Common Billing Problems with Skin Biopsies

Out-of-network pathology surprise

The most common billing shock with skin biopsies is an out-of-network pathology bill. Your dermatologist is in-network, but the lab they send specimens to operates independently. The No Surprises Act (effective 2022) provides some protection for out-of-network charges at in-network facilities, but enforcement varies. Always ask which pathology lab will process your specimen and verify network status with your insurer before the biopsy.

Separate E/M charge on the same visit (modifier -25)

If you visit the dermatologist for a skin check and a biopsy is performed, the provider may bill both an office visit (99213/99214 with modifier -25) and the biopsy (11102). This is appropriate when the dermatologist performs a separate evaluation beyond just the biopsy. However, if the sole purpose of the visit was "check this mole," the additional E/M charge may not be justified. Review your bill for both an office visit code and the biopsy code on the same date.

Multiple lesion billing adds up fast

If the dermatologist biopsies three suspicious spots, expect the following charges: one 11102 (first lesion), two 11103 (each additional lesion), and three separate 88305 pathology charges (one per specimen). This can total $700 to $1,200 or more. Ask before the procedure: "How many lesions do you recommend biopsying today, and what will the total cost be including pathology?" You may want to prioritize the most concerning lesions and schedule others for a follow-up visit.

Wrong biopsy technique code

There are three families of skin biopsy codes: tangential/shave (11102-11103), punch (11104-11105), and incisional (11106-11107). Each has different RVUs and prices. If the dermatologist performed a shave biopsy but the bill shows a punch or incisional code, this is a coding error in the provider's favor. The operative note should describe the technique used.

Related Dermatology Codes

Code	Description	Medicare (Office)	Avg. Charge
11102	Tangential biopsy, first lesion	$95.53	$222.64
11103	Tangential biopsy, each additional lesion	$50.42	$116.58
11104	Punch biopsy, first lesion	$109.78	$258.31
88305	Surgical pathology, gross and micro exam	$70.71	$182.00
17110	Destruction of benign lesions, up to 14	$111.22	$236.99

Frequently Asked Questions

How much does a skin biopsy (CPT 11102) cost without insurance?

Without insurance, a shave skin biopsy billed under CPT 11102 costs $150 to $350 depending on the provider and location. The national average charge is $222.64. However, the biopsy is only part of the cost. A separate pathology charge (CPT 88305, averaging about $182) always follows for analyzing the tissue sample. Total out-of-pocket can exceed $400 for a single lesion. Many dermatologists offer a bundled cash rate that includes both the biopsy and basic pathology.

Why did I get a separate pathology bill after my skin biopsy?

Every skin biopsy specimen must be examined under a microscope by a pathologist to determine whether the tissue is benign, precancerous, or cancerous. This analysis is billed separately under CPT 88305. The pathologist is typically a different provider from your dermatologist, and their lab may be out-of-network even if your dermatologist is in-network. This is standard practice, not double billing.

What is the difference between CPT 11102 and 11103?

CPT 11102 covers the first lesion biopsied using the tangential (shave) technique. CPT 11103 is the add-on code for each additional lesion biopsied in the same session. For example, if three moles are biopsied in one visit, the billing would be 11102 x1 plus 11103 x2. Each specimen also generates its own separate pathology charge (88305). So three biopsies could produce five line items on your bills.

Can the pathology lab for my biopsy be out-of-network?

Yes. The pathology lab is a separate entity from your dermatologist's office. Even at an in-network dermatologist, the lab they send specimens to may not participate in your insurance plan. The No Surprises Act provides some protections, but it is still wise to ask your dermatologist upfront: "Which lab do you use for pathology, and is it in my insurance network?" If it is not, ask whether they can send the specimen to an in-network lab instead.

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