CPT code 11106 is a medical code used for billing and documentation of a single lesion skin biopsy.
CPT code 11106 is used to describe an incisional biopsy of the skin for a single lesion. This procedure involves the surgical removal of a portion of skin tissue from one lesion for diagnostic examination. It is typically performed to diagnose or rule out skin conditions, including cancers or other dermatological disorders.
For CPT code 11106, which pertains to an incisional biopsy of a single skin lesion, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the biopsy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple procedures are performed that are not usually reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used to indicate that a laboratory test was repeated on the same day to obtain subsequent (multiple) test results.
6. Modifier LT: Left side. This modifier is used to specify that the procedure was performed on the left side of the body.
7. Modifier RT: Right side. This modifier is used to specify that the procedure was performed on the right side of the body.
8. Modifier 50: Bilateral procedure. This modifier is used if the procedure was performed on both sides of the body.
9. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
10. Modifier 58: Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used if the biopsy is part of a planned series of procedures.
11. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used if the biopsy is unrelated to the original procedure performed.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11106 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage criteria, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any local coverage determinations (LCDs) or specific billing requirements that may apply to this CPT code.
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