Dermatology Billing Cheat Sheet (2026)
Dermatology denials almost always trace back to one of three mistakes: the wrong procedure family, an uncounted lesion, or a removal that reads as cosmetic. This page sorts the biopsy, destruction, and excision codes, the count and size rules that set payment, and the modifier 25 rule for a same-day visit.
Quick reference for dermatology billers. Last updated .
Top Dermatology CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 11102 | Tangential biopsy (shave) | $95.53 | $30.06 | 2.86 |
| 11104 | Punch biopsy | $121.25 | $38.08 | 3.63 |
| 17000 | Destruction of first lesion (cryotherapy) | $66.47 | $47.76 | 1.99 |
| 17003 | Destruction of additional lesions (2-14) | $6.35 | $1.67 | 0.19 |
| 17311 | Mohs surgery, first stage, head/neck | $667.02 | $286.91 | 19.97 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Dermatology billing services page.
Modifiers That Prevent Dermatology Denials
A significant, separately identifiable E/M on the same day as a biopsy or destruction. This is the single most important dermatology modifier.
Distinct procedures at separate anatomic sites or lesions that NCCI would bundle, such as a biopsy of one lesion and destruction of another.
A repeat procedure by the same physician, such as staged destruction sessions.
A staged or planned related procedure during the global period, such as a planned re-excision after pathology.
Site laterality or specificity where the payer requires it to adjudicate multiple-lesion claims.
An ABN is on file for a service likely deemed cosmetic or non-covered. It preserves the ability to bill the patient.
Top Dermatology Denials → Quick Fix
Match the code to the technique documented: 11102 tangential or shave, 11104 punch, 11106 incisional. The note must state the method.
Document the exact number of lesions destroyed. 17000 is the first lesion and 17003 each additional one, for 2 to 14. The count drives the units.
Link a covered diagnosis and document symptoms such as bleeding, pain, functional impairment, or a malignancy concern. Benign cosmetic removal is non-covered.
Append modifier 25 to the E/M and document a separately identifiable evaluation distinct from the procedure decision.
Bill the pathology (88305) under the correct entity and do not duplicate the professional and technical split between the dermatologist and the lab.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 11102 | 00170 | Anesthesia service included in surgical procedure |
| 11102 | 0213T | Misuse of Column Two code with Column One code |
| 11104 | 00170 | Anesthesia service included in surgical procedure |
| 11104 | 0213T | Misuse of Column Two code with Column One code |
| 17000 | 0213T | Misuse of Column Two code with Column One code |
| 17000 | 0216T | Misuse of Column Two code with Column One code |
| 17003 | 17340 | Misuse of Column Two code with Column One code |
| 17003 | 36591 | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
The technique used (shave, punch, or incisional) and the site. The code is technique-driven, not lesion-driven.
The exact lesion count and the method, such as cryotherapy. 17004 is for 15 or more lesions, so counts must be explicit.
The lesion size plus margins (the excised diameter) and pathology confirming malignancy. Size including margins sets the code.
The stage count, the blocks or sections per stage, and that the same physician acted as surgeon and pathologist.
A separate E/M note showing a distinct evaluation beyond the procedure, to support modifier 25.
Revenue Dermatology Practices Leave on the Table
Coding excisions by lesion size without including the surgical margins, which undersizes the code and the payment.
Losing same-day E/M revenue by omitting modifier 25 when a distinct evaluation occurred.
Under-counting destroyed lesions, billing 17000 only when 17003 units also apply.
Not billing the pathology component when the practice performs and reads its own specimens.
Dermatology Billing FAQ
Biopsy, destruction, or excision: how do I pick?
By what was done. A biopsy samples tissue and is technique-coded (11102, 11104, 11106). Destruction ablates a lesion and is count-driven (the 17000 series). Excision removes it with margins and is size-and-margin-driven (114xx benign, 116xx malignant). The note must support the family chosen.
When does modifier 25 apply in dermatology?
When the same-day E/M is significant and separately identifiable from the minor procedure, such as a full-body skin exam plus a biopsy of one finding. Document the E/M independently.
How do I avoid cosmetic denials?
Tie every removal to a covered diagnosis and document medical necessity such as bleeding, pain, growth, or malignancy suspicion. Use an ABN with modifier GA when the service is likely non-covered.
Does lesion size include the margin for excisions?
Yes. The excised diameter is the lesion plus the narrowest clinical margins. Documenting only the lesion size systematically undercodes malignant excisions.
Stop Losing Dermatology Revenue to Preventable Denials
Our AAPC-certified dermatology coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.