CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 11103

Skin Biopsy, Tangential (Shave), Each Additional Lesion

CPT 11103 is the add-on code billed for each additional skin biopsy beyond the first during a dermatology visit. The first lesion is billed under 11102 ($223 average charge), and each additional one adds $114.96 on average. What most patients don't realize: each biopsied specimen also generates a separate pathology fee (CPT 88305, about $182 each). Three biopsies at one visit can easily total $1,000 when you include pathology.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 11103 at a Glance

Average provider charge: $114.96
Medicare rate (office): $48.77
Medicare rate (facility): $13.02
Typical markup: 2.4x over Medicare office rate

Type: Add-on code (cannot be billed alone)
Primary code: 11102 (first lesion, $223 avg)
Pathology per specimen: 88305 ($182 avg)
Beneficiaries (2023): 807,911

How the Medicare Rate Is Calculated

Medicare values 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 11103:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time and skill for additional biopsy	0.32	0.32
Practice Expense RVU	Supplies, specimen handling, staff	1.09	0.04
Malpractice RVU	Professional liability insurance	0.03	0.03
Total RVU		1.44	0.39
x $33.4009	2026 conversion factor	$48.77	$13.02

Add-on code: CPT 11103 cannot be billed by itself. It must always accompany 11102 (the first lesion biopsy). The facility rate of $13.02 is dramatically lower because in a hospital or ASC, the facility covers almost all the supplies and overhead separately.

Medicare Rate by State

Medicare adjusts the national rate by location using Geographic Practice Cost Indices (GPCIs). Here is how the 11103 rate varies across states in the office setting:

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)	$38.53	$114.96	3.0x
California (Los Angeles)	$42.01	$114.96	2.7x
New York (Manhattan)	$42.04	$114.96	2.7x
Florida (Fort Lauderdale)	$39.42	$114.96	2.9x
Ohio	$35.28	$114.96	3.3x
Mississippi	$33.63	$114.96	3.4x
Arkansas	$33.18	$114.96	3.5x
Alaska	$49.37	$114.96	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 $114.96 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

The True Cost of Multiple Skin Biopsies

Most patients think a biopsy is a single charge. In reality, every biopsied specimen generates two charges: the biopsy itself and the pathology reading. Here is what multiple biopsies actually cost at average charges:

Lesions Biopsied	Biopsy Codes Billed	Biopsy Charges	Pathology (88305)	Total
1 lesion	11102	$223	$182	$405
2 lesions	11102 + 11103	$338	$364	$702
3 lesions	11102 + 11103 x2	$453	$546	$999
4 lesions	11102 + 11103 x3	$568	$728	$1,296

Why splitting across visits does NOT save money: If you spread 3 biopsies across 3 separate visits, you pay the first-lesion rate (11102, $223) each time instead of the add-on rate (11103, $115). Three separate visits would cost $669 in biopsy charges alone (vs. $453 together), plus you may also owe an office visit copay each time. When multiple lesions need biopsy, doing them together in one session is the most cost-effective approach.

Common Billing Problems with 11103

Pathology charges billed by a separate provider

The dermatologist collects the specimen, but the pathology lab reads it. This often means a separate bill from a pathologist you never met. If you have insurance, check whether the pathology lab is in-network. Out-of-network pathology is one of the most common surprise billing scenarios in dermatology. Under the No Surprises Act (2022+), you may have protections, but being aware of this split billing is important.

More biopsies than discussed

Some patients report that their dermatologist biopsied more lesions than they expected. Before the procedure begins, ask: "How many spots are you planning to biopsy today?" This gives you the opportunity to discuss which lesions are highest priority. If cost is a concern, you can ask the dermatologist to prioritize the most clinically suspicious spots and monitor others over time.

Office visit billed on top of biopsy

A dermatology office visit (99213 or 99214) is often billed in addition to the biopsy codes on the same date. This is legitimate when a separately identifiable evaluation and management service occurs (the physician evaluates your skin, decides which lesions need biopsy, and provides a plan). However, if the sole purpose of the visit was the biopsy and no other issues were addressed, the additional office visit charge may not be warranted.

Frequently Asked Questions

How much does each additional skin biopsy cost?

Each additional tangential (shave) skin biopsy (CPT 11103) costs an average of $114.96 at the provider's billed charge. Medicare pays $48.77 in an office setting. Remember that each biopsied specimen also generates a separate pathology charge (CPT 88305, approximately $182), so the true per-lesion cost including pathology is closer to $297 at average charges.

What is the total cost of 3 skin biopsies at one visit?

For 3 lesions biopsied in one visit, the billing is: 11102 (first lesion, $223 average) plus 11103 x 2 (additional lesions, $230 total) plus pathology 88305 x 3 ($546 total). The grand total at average charges is approximately $1,000. With insurance, your cost depends on your deductible and coinsurance. If your deductible is met and you have 20% coinsurance, expect to pay roughly $200.

Is it cheaper to spread skin biopsies across multiple visits?

No. Spreading biopsies across visits does not save money because you pay the higher first-lesion rate (11102, $223) at each visit instead of the lower add-on rate (11103, $115) for the 2nd and subsequent lesions. If 3 spots need biopsy, doing all 3 at one visit costs about $999 total, while doing them one per visit across 3 visits would cost about $1,215 (three first-lesion charges plus pathology), plus additional office visit copays.

Can I ask my dermatologist to biopsy fewer spots?

Yes. Before your dermatologist begins biopsying, you can ask: "How many are you planning to biopsy, and can we prioritize the most concerning ones?" If some spots are being biopsied "just to be safe" rather than because they appear clinically suspicious, you may be able to defer the less concerning ones. Your dermatologist can monitor them over time using photographs or clinical observation and biopsy only if changes occur.

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