How much does Medicare pay for CPT 11104?

Medicare allowed an average of $108.60 per service and paid $79.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $283.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11104?

Punch biopsy, first skin growth. It was billed 182,599 times to 171,892 Medicare beneficiaries by 6,608 providers in 2024.

Does 11104 pay differently in an office than a hospital?

Yes. The allowed amount averaged $111.97 in an office setting and $41.17 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 11104 most?

Dermatology, with 113,669 services from 3,923 clinicians. Next are Physician Assistant, Nurse Practitioner, Neurology.

CPT 11104

Punch biopsy, first skin growth

$108.60Medicare-allowed amount per service, averaged across 182,599 services

Providers submitted

$283.68

Asking price, not received

Medicare allowed

$108.60

The fee schedule figure

Medicare paid

$79.15

Balance is patient coinsurance

Providers submitted an average of $283.68 for this code and Medicare allowed $108.60 — 2.6× 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 $79.15 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $111.97
Hospital / facility: $41.17

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. 173,908 services were billed in an office setting and 8,691 in a facility.

Services: 182,599
Beneficiaries: 171,892
Providers billing it: 6,608
Total allowed: $19,830,251

What Medicare pays for CPT 11104

Across 182,599 services billed by 6,608 providers to 171,892 beneficiaries, Medicare allowed an average of $108.60 per service. 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 11104

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	113,669	106,258	$114.30	3,923
Physician Assistant	36,122	34,356	$98.19	1,396
Nurse Practitioner	18,085	17,311	$93.19	665
Neurology	4,110	4,089	$110.80	170
Family Practice	2,369	2,222	$111.25	110
Plastic and Reconstructive Surgery	2,111	1,914	$108.69	72
Podiatry	1,508	1,421	$112.02	68
Micrographic Dermatologic Surgery	1,299	1,250	$107.24	50
Otolaryngology	934	860	$97.31	44
Internal Medicine	821	744	$114.46	32
General Surgery	558	534	$92.40	30
General Practice	163	145	$112.56	8
Pathology	142	137	$119.24	5
Surgical Oncology	83	77	$95.58	5
Hematology-Oncology	81	81	$103.86	2

11104 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	20,681	$113.41	$83.69	653
California	19,928	$127.21	$81.26	647
Texas	9,602	$107.33	$80.53	399
Illinois	8,594	$111.64	$80.21	271
New York	6,943	$121.07	$82.98	283
Virginia	6,036	$112.38	$80.69	198
Pennsylvania	5,904	$106.28	$77.03	258
Massachusetts	5,768	$111.92	$76.38	199
Indiana	5,430	$87.01	$66.35	131
Tennessee	5,341	$100.53	$79.14	180
North Carolina	5,305	$102.88	$78.54	232
Arizona	5,185	$110.81	$81.79	197
Washington	4,961	$104.70	$69.78	184
Maryland	4,664	$119.46	$81.82	154
Georgia	4,224	$106.99	$82.00	175
Ohio	4,196	$97.89	$75.53	184
Michigan	3,874	$109.74	$82.15	137
South Carolina	3,801	$103.07	$80.20	147
New Jersey	3,583	$125.75	$85.86	131
Kentucky	3,262	$100.31	$80.06	99
Wisconsin	3,145	$86.58	$64.50	111
Oregon	3,087	$108.68	$76.45	122
Missouri	3,016	$96.37	$74.30	127
Kansas	2,874	$97.25	$75.94	80
Iowa	2,743	$91.95	$71.44	88
Alabama	2,583	$96.99	$80.80	85
Minnesota	2,313	$90.85	$65.09	113
Louisiana	2,127	$101.49	$81.54	80
Colorado	2,060	$116.93	$80.75	80
Arkansas	2,060	$91.02	$74.24	82
Mississippi	1,809	$102.01	$86.48	66
West Virginia	1,764	$90.03	$69.81	62
Oklahoma	1,514	$103.14	$81.01	67
Delaware	1,467	$109.96	$80.59	33
Montana	1,350	$100.33	$68.35	47
Idaho	1,294	$98.21	$75.03	48
Nebraska	1,283	$101.98	$79.25	51
Utah	1,176	$100.26	$74.69	53
New Hampshire	1,009	$102.08	$73.00	48
Nevada	911	$112.62	$79.85	43
Connecticut	805	$119.50	$79.88	46
South Dakota	737	$67.34	$51.02	33
New Mexico	691	$106.09	$79.44	31
North Dakota	662	$66.14	$48.55	29
Wyoming	512	$114.90	$79.29	14
Alaska	455	$126.37	$79.84	17
District of Columbia	423	$133.97	$84.89	18
Rhode Island	378	$114.83	$81.44	21
Vermont	360	$83.52	$58.34	16
Hawaii	348	$121.59	$83.28	18
Maine	263	$106.00	$78.30	15
Puerto Rico	51	$122.32	$93.63	4
U.S. Virgin Islands	47	$123.71	$74.55	1

Related codes

11102Biopsy of related skin growth$83.12
11103Biopsy of related skin growth$46.68
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.