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11100
Quick jump to procedure code: Printer Friendly Version
1110F

CPT® 11101: BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED; EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Short Description: Biopsy skin add-on

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$ 33.32
$ 25.80


*Based on National 2013 Medicare Part B submitted claims.

2016 OPPS Status Indicator: N

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
34.0% 238.2    Neoplasm of uncertain behavior of skin D48.5   Neoplasm of uncertain behavior of skin
20.1% 702.0    Actinic keratosis L57.0   Actinic keratosis
6.2% V10.83    Personal history of malignant neoplasm, other malignant neoplasm of skin Z85.828   Personal history of other malignant neoplasm of skin
4.0% 702.19    Other seborrheic keratosis L82.1   Other seborrheic keratosis
3.4% 702.11    Inflamed seborrheic keratosis L82.0   Inflamed seborrheic keratosis
2.8% 239.2    Neoplasms of unspecified nature of bone, soft tissue, and skin D49.2   Neoplasm of unspecified behavior of bone, soft tissue, and skin
2.0% 173.3    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
1.6% 216.5    Benign neoplasm of skin of trunk, except scrotum D23.5   Other benign neoplasm of skin of trunk
1.4% 709.09    Other disorders of skin and subcutaneous tissue L81.8   Other specified disorders of pigmentation
1.4% 692.9    Contact dermatitis and other eczema, unspecified cause L25.9   Unspecified contact dermatitis, unspecified cause

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

11101 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 11101

CCI and MUE Edits*         Hide this section.

CCI Edits for 11101
Denied Codes (1) Effective Modifier
Accepted (2)
36591 Draw blood off venous device 10/01/2015 No
36592 Collect blood from picc 10/01/2015 No
(1) These codes will be denied when submitted for payment on the same date of service as 11101.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 11101

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 6 6 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   11101 Top 5 Ordering Providers National*
THI TRAN -THE VILLAGES,FL 8,085
ELIAHOU COHEN -DELRAY BEACH,FL 7,074
JOSEPH GRETZULA -BOYNTON BEACH,FL 6,835
JOSHUA BERLIN -BOYNTON BEACH,FL 6,152
MARIA KENDALL -CORAL GABLES,FL 5,574

   11101 Top 5 Ordering Organizations National*
ZITELLI & BRODLAND PC-PA 417
ZITELLI & BRODLAND PC-PA 342
THE PLASTIC SURGERY CENTER LAND, LLC-GA 97
RICHARD C CONNORS MD PC-CT 87
UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION-AL 43

*Based on 2013 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 11101*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 1,456,849
Total Services Denied 2014: 75,739 (5.2%)
National Charges Submitted 2014: $100,400,589.00
National Charges Allowed 2014: $ 44,296,748.00
National Average (No Modifier) Fee Submitted 2014: $ 69.05
National Average (No Modifier) Fee Allowed 2014: $ 32.00


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Dermatology 1,178,432 80.9% $ 67.93 56,479 4.8%
Physician assistant
(eff 5/92)
137,666 9.4% $ 65.36 6,196 4.5%
Nurse practitioner 52,658 3.6% $ 70.23 2,340 4.4%
Family practice 21,206 1.5% $ 67.96 2,170 10.2%
Plastic and reconstructive surgery 14,645 1.0% $ 92.21 2,151 14.7%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 1,399,613 96.1% $ 67.82 71,013 5.1%
Outpatient hospital 49,283 3.4% $ 87.57 3,343 6.8%
Inpatient hospital 2,766 0.2% $ 95.87 305 11.0%
Ambulatory surgical center 2,349 0.2% $313.47 795 33.8%
Home 636 0.0% $ 52.10 59 9.3%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 923,280 63.4% $ 69.05 47,410 5.1%
59 - Distinct Procedural Service 464,684 31.9% $ 67.52 23,164 5.0%
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period 28,021 1.9% $ 68.95 1,987 7.1%
76 - Repeat Procedure by Same Physician 19,575 1.3% $ 65.78 1,612 8.2%
GC 12,082 0.8% $105.96 582 4.8%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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05/04/2016 07:56:32 54.145.23.244

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