The jury is still out on many of the proposals outlined in the July 2018 Centers for Medicare & Medicaid Services (CMS) guidance, but the new biopsy codes are a sure thing.

As of January 1, 2019, codes 11100 and 11101 will be deleted from the Current Procedural Terminology (CPT) Book. The six new skin biopsy codes include:

  • 11X02 Tangential biopsy of skin, (eg, shave, scoop, saucerize, curette), single lesion
  • 11X04 Punch biopsy of skin, (including simple closure when performed), single lesion
  • 11X06 Incisional biopsy of skin (eg, wedge), (including simple closure when performed), single lesion
  • 11X03 Tangential biopsy of skin, (eg, shave, scoop, saucerize, curette), each separate/additional lesion
  • 11X05 Punch biopsy of skin, (including simple closure when performed), each separate/additional lesion
  • 11X07 Incisional biopsy of skin (eg, wedge), (including simple closure when performed), each separate/additional lesion

In general reimbursements for tangential biopsies will be 10.6 percent less than for 2018, and reimbursements for punch biopsies will be 12.5 percent more. Incisionals will reimburse at a rate that is 35.5 percent higher than last year. The same reimbursement framework holds for additional lesions.

Please note that the “X” in each code number will probably be replaced by a “1” when the new codes are finalized. Official code descriptors for these codes will not be released by the American Medical Association until October. After the code descriptors are released, the American Academy of Dermatology Association will provide more information.

Mark D. Kaufmann, MD is an associate Clinical Professor of Dermatology, Dept. of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.