How much does Medicare pay for CPT 11103?

Medicare allowed an average of $46.68 per service and paid $35.98 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $115.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11103?

Biopsy of related skin growth, each additional growth. It was billed 1,418,195 times to 827,212 Medicare beneficiaries by 14,379 providers in 2024.

Does 11103 pay differently in an office than a hospital?

Yes. The allowed amount averaged $47.07 in an office setting and $20.52 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 11103 most?

Dermatology, with 912,083 services from 8,352 clinicians. Next are Physician Assistant, Nurse Practitioner, Micrographic Dermatologic Surgery.

CPT 11103

Biopsy of related skin growth, each additional growth

$46.68Medicare-allowed amount per service, averaged across 1,418,195 services

Providers submitted

$115.87

Asking price, not received

Medicare allowed

$46.68

The fee schedule figure

Medicare paid

$35.98

Balance is patient coinsurance

Providers submitted an average of $115.87 for this code and Medicare allowed $46.68 — 2.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $35.98 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $47.07
Hospital / facility: $20.52

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,396,910 services were billed in an office setting and 21,285 in a facility.

Services: 1,418,195
Beneficiaries: 827,212
Providers billing it: 14,379
Total allowed: $66,201,343

What Medicare pays for CPT 11103

Across 1,418,195 services billed by 14,379 providers to 827,212 beneficiaries, Medicare allowed an average of $46.68 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 11103

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	912,083	523,317	$49.51	8,352
Physician Assistant	337,934	203,665	$41.28	3,986
Nurse Practitioner	128,948	79,047	$40.25	1,621
Micrographic Dermatologic Surgery	17,962	10,169	$48.86	208
Family Practice	6,714	3,832	$48.60	70
General Practice	3,626	966	$42.69	8
Plastic and Reconstructive Surgery	2,691	1,415	$47.40	36
Internal Medicine	2,672	1,665	$48.59	31
Pathology	1,464	840	$49.87	16
Undefined Physician type	723	329	$50.35	5
Pediatric Medicine	649	311	$49.51	4
Podiatry	618	395	$54.16	11
Otolaryngology	321	209	$49.94	11
Osteopathic Manipulative Medicine	310	194	$49.15	5
Preventive Medicine	303	133	$45.75	1

11103 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	297,305	$46.76	$36.12	1,661
California	136,035	$53.24	$36.55	1,298
Texas	82,504	$46.04	$36.02	986
New York	79,496	$54.07	$37.17	798
Pennsylvania	58,854	$45.48	$34.66	587
Georgia	51,829	$43.65	$34.70	466
Arizona	51,470	$45.72	$34.77	423
New Jersey	49,020	$52.96	$36.69	455
North Carolina	47,630	$43.74	$34.82	577
Illinois	41,416	$46.66	$35.21	468
Tennessee	36,492	$41.54	$34.66	350
Virginia	35,883	$46.83	$35.54	395
Massachusetts	35,313	$49.19	$36.13	432
South Carolina	29,615	$42.86	$34.59	238
Ohio	27,250	$42.31	$34.23	423
Maryland	22,453	$50.43	$36.15	268
Alabama	22,160	$41.67	$35.25	228
Michigan	20,216	$44.94	$35.16	336
Washington	19,662	$45.63	$32.86	310
Missouri	19,379	$42.84	$34.00	236
Colorado	19,186	$48.27	$35.87	299
Indiana	18,215	$42.95	$34.35	240
Kentucky	15,651	$42.89	$35.99	170
Connecticut	13,908	$50.81	$35.92	191
Wisconsin	13,519	$38.13	$30.07	208
Minnesota	12,970	$42.86	$32.38	227
Oregon	12,075	$45.83	$33.80	193
Kansas	10,666	$41.78	$33.71	129
Louisiana	10,419	$43.39	$36.52	146
Mississippi	10,217	$41.26	$35.59	106
Iowa	10,164	$39.96	$32.17	132
Arkansas	10,072	$39.56	$33.95	119
Nevada	9,878	$44.96	$34.40	113
Oklahoma	9,317	$42.45	$35.12	128
Utah	8,614	$43.63	$34.07	153
South Dakota	7,251	$36.47	$28.78	61
New Mexico	6,590	$42.11	$33.90	70
Delaware	6,384	$48.01	$36.87	44
New Hampshire	6,290	$42.78	$31.70	85
Idaho	5,791	$39.05	$30.71	99
Nebraska	5,501	$40.56	$33.19	78
West Virginia	5,050	$38.49	$31.40	81
Montana	4,867	$44.43	$32.85	63
Maine	4,374	$46.87	$35.96	52
Rhode Island	4,157	$45.75	$33.92	75
North Dakota	2,403	$27.56	$21.00	31
Wyoming	2,352	$45.43	$34.15	31
Hawaii	2,352	$52.10	$37.15	35
Vermont	2,264	$38.09	$29.19	32
Alaska	1,682	$54.37	$37.34	15
District of Columbia	1,337	$53.10	$37.12	26
Puerto Rico	608	$48.83	$37.86	10
Guam	65	$49.52	$38.33	1
U.S. Virgin Islands	24	$49.58	$37.58	1

Related codes

11102Biopsy of related skin growth$83.12
11104Punch biopsy, first skin growth$108.60
11105Punch biopsy, each additional skin growth$51.22
11106Incision biopsy$139.34
11107Incision biopsy$68.45

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.