If you have ever looked at a dermatology bill and felt confused, you are not alone. The numbers and abbreviations look like a secret language. But here is the truth: those codes are your key to getting claims paid correctly, avoiding denied claims, and keeping a practice profitable.
A dermatologist CPT code is more than a random five-digit number. It tells an insurance company exactly what a doctor did, why they did it, and how complex the work was. Use the wrong code, and your claim may get rejected. Use the right one, and payment flows smoothly.
This guide walks you through the most common dermatology codes. We will look at evaluation and management (E/M) codes, biopsy codes, destruction codes, and excision codes. You will learn how to tell a simple shave removal from a complex layered closure. You will also see how to avoid the costly mistake of under-coding or over-coding.
Let us start with the foundation: what these codes actually mean in a dermatology setting.
Understanding the Basics of Dermatology CPT Codes
Before we jump into specific numbers, you need to understand how the system works. CPT stands for Current Procedural Terminology. The American Medical Association (AMA) maintains and updates these codes every year.
For dermatology, you will use codes from several sections of the CPT manual:
- Evaluation and Management (99202-99215) – For office visits and consultations.
- Integumentary System (10000-19999) – For skin, hair, and nails procedures.
- Pathology and Laboratory (80000-89999) – For biopsy readings.
Every code has three key parts: the code number, a description, and a relative value unit (RVU). RVUs determine how much Medicare and private payers reimburse.
But here is a critical point: documentation must match the code. You cannot bill for a complex excision if the medical record only describes a simple shave. Payers audit these records regularly.
Important Note for Readers: Always verify payer-specific guidelines. Medicare may have different rules than a commercial insurance plan. When in doubt, ask your billing specialist or reference the current CPT manual.
Evaluation and Management (E/M) Codes for Dermatology
Every dermatology visit starts with an E/M code. This code covers the provider’s work to assess the patient: taking a history, performing an exam, and making medical decisions.
In 2021, the AMA simplified E/M coding for office visits. The changes removed the old requirement to count history and exam elements. Now, the key factor is medical decision making (MDM) or time.
New vs. Established Patient Codes
Dermatologists use two sets of E/M codes:
- New patient (99202-99205) – The patient has not received professional services from the provider or another provider of the same specialty in the same group within the past three years.
- Established patient (99212-99215) – The patient has seen the provider or another provider of the same specialty in the same group within the past three years.
Here is a simple table to help you choose the right level:
| Code | Patient Type | Typical Dermatology Visit | Key Driver |
|---|---|---|---|
| 99202 | New | Minor acne or one lesion check; straightforward MDM | 15-29 min or straightforward MDM |
| 99203 | New | Wart check, mild psoriasis; low MDM | 30-44 min or low MDM |
| 99204 | New | Total body skin exam with multiple lesions; moderate MDM | 45-59 min or moderate MDM |
| 99205 | New | Complex medical case (severe HS or autoimmune disease); high MDM | 60-74 min or high MDM |
| 99212 | Established | Routine med refill; straightforward MDM | 10-19 min or straightforward MDM |
| 99213 | Established | Acne follow-up, one wart treatment; low MDM | 20-29 min or low MDM |
| 99214 | Established | Total body skin exam on history of melanoma; moderate MDM | 30-39 min or moderate MDM |
| 99215 | Established | Complex medication management for severe dermatitis; high MDM | 40-54 min or high MDM |
Time includes all work on the day of the visit: preparing to see the patient, obtaining history, performing exam, counseling, ordering tests, and documenting.
Medical decision making looks at three things:
- Number of diagnoses or management options
- Amount of data to review (tests, images, external notes)
- Risk of complications, morbidity, or mortality
For most straightforward dermatology visits (one wart, one cyst, simple rash), 99213 for established patients is the most common code. For new patients with a full skin exam and multiple actinic keratoses, 99203 or 99204 is often appropriate.
Prolonged Services
Sometimes a visit runs longer than the typical time for the highest level code. For those cases, you can add prolonged service codes.
- +99417 – Each additional 15 minutes beyond the highest level code for office/outpatient E/M (use with 99205 or 99215)
You cannot use this code for every visit. Only use it when the total time passes the threshold of 99205 (74+ min for new patients) or 99215 (54+ min for established patients).
Biopsy CPT Codes in Dermatology
Dermatologists perform biopsies daily. The right code depends on the technique and the anatomic site.
Common Biopsy Codes
| CPT Code | Description | Typical Use |
|---|---|---|
| 11102 | Tangential biopsy of skin (single lesion) | Shave biopsy for a raised lesion |
| 11103 | Tangential biopsy of skin (each separate/additional lesion) | Second or third shave biopsy |
| 11104 | Punch biopsy of skin (single lesion) | Punch for a pigmented lesion or deep dermal process |
| 11105 | Punch biopsy of skin (each separate/additional lesion) | Additional punch biopsies |
| 11106 | Incisional biopsy of skin (single lesion) | Deep wedge biopsy for panniculitis or deep tumor |
| 11107 | Incisional biopsy of skin (each separate/additional lesion) | Multiple incisional biopsies |
Tangential biopsy (shave) removes a lesion at the skin surface level. You use this for raised lesions like seborrheic keratoses or nevus. You do not go deep into the dermis.
Punch biopsy uses a circular blade to remove a full-thickness core of skin. You use this for rashes, suspected melanoma, or when you need dermal tissue.
Incisional biopsy removes a small wedge or ellipse of tissue. You use this for larger lesions or when you need deeper tissue, such as in suspected panniculitis.
Important: Do not bill a biopsy code if you perform a total excision of a lesion and send it to pathology. Total excision uses excision codes (11400-11646). Only use biopsy codes when you sample a portion of a lesion or take a small diagnostic sample without complete removal.
Modifiers for Biopsies
When you perform multiple biopsies on the same day, you may need a modifier. For separate lesions or separate sites, list each biopsy code on a separate line. Most payers allow multiple biopsies without a modifier as long as the lesions are distinct and you document each site.
If you perform two different techniques on the same lesion (example: punch then shave), that is unusual and likely not separately billable. Always check payer policies.
Destruction CPT Codes for Benign and Premalignant Lesions
Destruction means ablating tissue without removing a specimen for pathology. Common destruction methods include cryosurgery (liquid nitrogen), electrosurgery, and laser ablation.
Destruction by Method
| CPT Code | Description | Use This For |
|---|---|---|
| 17000 | Destruction of first premalignant lesion (actinic keratosis) | First AK treated |
| 17003 | Destruction of second through 14th lesion, each | Lesions 2-14 in same session |
| 17004 | Destruction of 15 or more lesions | Extensive AKs |
| 17110 | Destruction of up to 14 benign lesions | Seb K, warts, skin tags (not plantar or genital warts) |
| 17111 | Destruction of 15 or more benign lesions | Multiple seborrheic keratoses |
Watch out for 17003. This code is an add-on code. You never bill it alone. First, you bill 17000 for the first lesion. Then, for each additional lesion from 2 to 14, you bill 17003.
Example: A patient comes in with 10 actinic keratoses on the face. You treat all with liquid nitrogen. Your bill would show:
- 17000 (first AK)
- 17003 x 9 (nine lines or one line with 9 units, depending on payer)
For 15 or more AKs, you use 17004 once. Do not use 17000 or 17003 with 17004. The 17004 code covers all lesions in that session.
For benign lesions like seborrheic keratoses, skin tags, or common warts (excluding plantar), use 17110 for up to 14 lesions. Use 17111 for 15 or more.
Do not use destruction codes when you perform a shave biopsy and do not send pathology. If you shave off a lesion and discard it, that is destruction. If you shave it and send it to path, that is biopsy (11102) .
Excision CPT Codes for Benign and Malignant Lesions
Excision means cutting out a lesion completely, including a margin of normal skin, and closing the wound with sutures. Excision codes require a specimen to be sent to pathology.
The key to picking the right excision code is measuring the excised diameter, not the lesion diameter alone.
How to Measure Excision Size
Many new coders make this mistake. They only measure the lesion. But CPT rules say: measure the greatest clinical diameter of the lesion plus the narrowest margin required to excise the lesion completely.
Example: A patient has a 6mm pigmented lesion. You excise it with 2mm margins on each side. The total excised diameter is:
- 6mm (lesion) + 2mm (left margin) + 2mm (right margin) = 10mm
You would choose an excision code based on 1.0 cm, not 0.6 cm. Document the excised diameter in the operative note. If you do not, the coder cannot bill correctly.
Benign Lesion Excision Codes (11400-11446)
| CPT Code | Excised Diameter |
|---|---|
| 11400 | 0.6 cm or less |
| 11401 | 0.7 to 1.0 cm |
| 11402 | 1.1 to 2.0 cm |
| 11403 | 2.1 to 3.0 cm |
| 11404 | 3.1 to 4.0 cm |
| 11406 | Over 4.0 cm |
Use these codes for benign lesions like lipomas, cysts, nevi, and seborrheic keratoses that you fully excise.
Malignant Lesion Excision Codes (11600-11646)
| CPT Code | Excised Diameter |
|---|---|
| 11600 | 0.6 cm or less |
| 11601 | 0.7 to 1.0 cm |
| 11602 | 1.1 to 2.0 cm |
| 11603 | 2.1 to 3.0 cm |
| 11604 | 3.1 to 4.0 cm |
| 11606 | Over 4.0 cm |
Use these for basal cell carcinoma, squamous cell carcinoma, melanoma, and other malignant neoplasms.
The malignant codes pay more than benign codes because the complexity of margins and follow-up is higher.
What About Closure?
For simple closures (single layer, superficial sutures, staples, or adhesive strips), closure is included in the excision code. Do not bill separately.
For intermediate closures (layered closure of deep tissues plus superficial skin closure), you bill +12031-12057 in addition to the excision code.
For complex closures (scar revision, undermined edges, extensive debridement), you bill +13100-13153.
Important Note: You cannot bill an excision and a destruction on the same lesion in the same session. Pick one. You also cannot bill a biopsy and an excision on the same lesion. If you biopsy a lesion and later excise it in a separate session, that is fine. But in one session, you do one or the other.
Shaving of Epidermal or Dermal Lesions (11300-11313)
Shave removals sit in a gray area. They are not excisions (no deep margin and often no sutures). They are not destructions (you send a specimen to pathology).
CPT has specific codes for shave removals:
| CPT Code | Lesion Diameter |
|---|---|
| 11300 | 0.5 cm or less |
| 11301 | 0.6 to 1.0 cm |
| 11302 | 1.1 to 2.0 cm |
| 11303 | 2.1 to 3.0 cm |
| 11305 | Over 3.0 cm (scalp, neck, hands, feet, genitalia) |
| 11306 | Over 3.0 cm (other anatomic site) |
Use these codes when you remove a raised lesion by shaving it flat with the skin surface and send the tissue to pathology. This is common for seborrheic keratoses, dermal nevi, and papillomas.
If you use a shave technique but do not send the tissue to pathology (you discard it), then you should use destruction codes (17110-17111) instead.
Mohs Micrographic Surgery CPT Codes
Mohs surgery is a specialized technique for removing skin cancer. The surgeon acts as both surgeon and pathologist, examining 100% of the surgical margins.
Mohs Codes
| CPT Code | Description |
|---|---|
| 17311 | Mohs micrographic technique, first stage, up to 5 tissue blocks |
| 17312 | Each additional stage after the first, up to 5 tissue blocks |
| 17313 | Mohs, first stage, 6 or more blocks |
| 17314 | Each additional stage, 6 or more blocks |
| 17315 | Each additional block after 5 blocks in any stage |
Important: You cannot bill Mohs codes if a non-physician performs the pathology reading. The Mohs surgeon must read the slides. Also, repair codes are separate. After Mohs, the closure (repair) is billed with intermediate or complex repair codes, not excision codes.
Repair (Closure) Codes
After an excision or Mohs, you may need to close the wound. Repair codes divide into three levels: simple, intermediate, and complex.
Simple Repair (12001-12007)
| Code | Wound Length | Location |
|---|---|---|
| 12001 | 2.5 cm or less | Scalp, neck, axillae, genitalia, trunk, extremities |
| 12002 | 2.6 cm to 7.5 cm | Same as above |
| 12004 | 7.6 cm to 12.5 cm | Same as above |
| 12005 | 12.6 cm to 20.0 cm | Same as above |
| 12006 | Over 20.0 cm | Same as above |
Simple repair uses a single layer of closure (usually superficial sutures, staples, or adhesive strips). No deep layer work.
Intermediate Repair (12031-12057)
| Code | Wound Length | Location |
|---|---|---|
| 12031 | 2.5 cm or less | Scalp, neck, axillae, genitalia, trunk, extremities |
| 12032 | 2.6 cm to 7.5 cm | Same as above |
| 12034 | 7.6 cm to 12.5 cm | Same as above |
| 12035 | 12.6 cm to 20.0 cm | Same as above |
| 12036 | Over 20.0 cm | Same as above |
Intermediate repair requires layered closure of deep tissues (subcutaneous layer) plus superficial skin closure.
Complex Repair (13100-13153)
Complex repair includes extensive undermining, scar revision, debridement, or complex wound closure (like flaps other than Z-plasty).
Repair After Mohs or Excision
- If the excision is simple (elliptical excision with simple layered closure), the repair is usually intermediate.
- If the wound is closed with a complex flap or graft, use complex repair codes.
Never bill a repair with an excision when the closure is simple. That repair is included. Always add repairs for intermediate or complex closures.
Cyst and Lipoma Removal Codes
For cysts and lipomas, you have two coding options depending on the depth and complexity.
- 11400-11406 – Superficial benign lesion excision (cyst or lipoma in subcutaneous tissue)
- 10060-10061 – Incision and drainage of cyst (if infected, no excision)
For deeper lipomas or cysts requiring more extensive dissection, you may use 11406 (over 4.0 cm) or consider an excision code under the musculoskeletal system if it involves fascia. But for routine dermatology cysts and lipomas, 11400-11406 are appropriate.
Nail Procedure Codes
Dermatologists treat nail conditions frequently. Here are the most common codes:
| CPT Code | Procedure |
|---|---|
| 11730 | Avulsion of nail plate, partial or complete, single |
| 11732 | Each additional nail plate avulsion |
| 11750 | Excision of nail and matrix (permanent removal) |
| 11755 | Biopsy of nail unit |
| 11765 | Excision of nail fold (ingrown nail with wedge resection) |
Nail avulsion (11730) removes the nail plate. It does not destroy the matrix. The nail grows back.
Permanent removal (11750) destroys the nail matrix so the nail never regrows. This is for chronic ingrown nails or painful nail deformities.
Common Modifiers for Dermatology
Modifiers are two-digit codes added to a CPT code to give more information. They do not change the procedure, but they change payment or bundling rules.
| Modifier | Meaning | When to Use in Dermatology |
|---|---|---|
| -25 | Significant, separately identifiable E/M service on same day as procedure | Patient has a rash visit (E/M) AND you freeze a wart (17110) in same visit |
| -59 | Distinct procedural service | Two separate procedures on different anatomic sites that normally bundle |
| -58 | Staged or related procedure by same physician during postoperative period | Planned re-excision for positive margins |
| -76 | Repeat procedure by same physician | Same procedure on same day, different lesion (document well) |
| -LT / -RT | Left side / Right side | Excisions on left arm and right arm |
| -51 | Multiple procedures | Use only if payer requires (Medicare does not prefer -51 for most codes; use -59 or separate lines) |
Modifier -25 is one of the most misused and audited modifiers. You cannot just append it. You must document that the E/M service went beyond the usual pre-procedure work. The rash evaluation must be separate and significant from the wart treatment.
ICD-10 Codes Must Match CPT
CPT codes never stand alone. Every claim also requires an ICD-10-CM diagnosis code. The diagnosis code tells the payer why you performed the procedure.
Some common ICD-10 codes for dermatology:
- L57.0 – Actinic keratosis
- C44.xxx – Basal cell carcinoma (site specific)
- D22.xxx – Melanocytic nevi
- L72.1 – Epidermal cyst
- B07.8 – Viral wart
Medical necessity is the golden rule: The diagnosis code must justify the procedure code. A destruction of AK (17000) with a diagnosis of acne (L70.0) will deny. A biopsy of a pigmented lesion (11104) with a diagnosis of benign nevus (D22.5) may pay, but a diagnosis of rash (R21) will raise red flags.
Bundling Rules You Must Know
National Correct Coding Initiative (NCCI) edits bundle certain codes. You cannot bill both codes together unless you use a modifier and prove separate sites or separate sessions.
Common dermatology bundles:
- Biopsy with destruction on same lesion – Do not bill both. Choose one.
- Excision with destruction on same lesion – Do not bill both.
- E/M with minor procedure – E/M requires modifier -25 and separate documentation.
- Biopsy of a lesion in the same area as an excision – Usually bundled. You biopsy OR excise, not both.
Always check NCCI edits before billing two codes on the same date of service.
Documentation Essentials to Support Your Code
Insurance auditors love dermatology. Why? Because skin procedures are visible, measurable, and easy to audit. Your documentation must protect you.
For every lesion procedure, document:
- Location (right forearm, left cheek, central back)
- Size (in centimeters or millimeters)
- Description (color, shape, border, elevation)
- Diagnosis (clinical impression)
- Procedure performed (shave, punch, excision, destruction)
- Exact measurement (if excision: excised diameter including margins)
- Number of lesions (if destruction: first, second, etc.)
- Closure method (if any)
For E/M visits, document:
- History (pertinent elements only)
- Exam (relevant skin findings)
- Medical decision making (data reviewed, diagnoses considered, risk)
- Time (if billing based on time: total time and what you did during that time)
Quote from a Coding Auditor: “I see denials every day because a doctor wrote ‘shave lesion left arm’ and nothing else. No size. No description. No number. The coder cannot guess. When in doubt, document more, not less.”
Putting It All Together: Real-World Scenarios
Let us walk through common dermatology visits and see the correct codes in action.
Scenario 1: New Patient, Full Skin Exam, One Lesion Biopsy
A 55-year-old new patient comes for a total body skin exam. You find one suspicious 8mm pigmented lesion on the back. You perform a punch biopsy (11104). You document time: 35 minutes total.
Codes:
- 99203 (new patient, 30-44 minutes of time, moderate MDM possible)
- 11104 (punch biopsy, single lesion)
Do you need modifier -25 on 99203? No. The biopsy is a separate procedure, and the E/M was significant. However, some payers require -25. Check your payer policy. Medicare typically wants -25 on the E/M code.
Scenario 2: Established Patient, Acne Follow-Up + Wart Destruction
A 19-year-old established patient comes for acne check. You spend 15 minutes on acne (review meds, prescribe topicals). The patient also mentions a wart on the left index finger. You freeze that wart (first lesion, use 17110 because wart is benign). Total time 22 minutes.
Codes:
- 99213 (established patient, low MDM, 20-29 minutes)
- 17110 (destruction of benign lesion, up to 14 lesions)
- Modifier -25 on 99213 (separate, significant E/M beyond the wart treatment)
Documentation must show the acne management was separate from the wart destruction.
Scenario 3: Excision of Basal Cell Carcinoma on the Nose
A patient has a 0.9 cm basal cell carcinoma on the right nasal ala. You excise it with 2mm margins. Total excised diameter = 0.9 + 0.2 + 0.2 = 1.3 cm. You close with layered closure (intermediate repair). Total wound length = 2.0 cm.
Codes:
- 11602 (malignant excision, 1.1 to 2.0 cm)
- 12032 (intermediate repair, 2.6 to 7.5 cm? Wait. Wound is 2.0 cm. That falls under 12031 for 2.5 cm or less, not 12032.)
Correction: Wound length 2.0 cm → 12031 (intermediate repair, 2.5 cm or less)
Biopsy? No. You excised the whole lesion.
Scenario 4: Multiple Actinic Keratoses, 20 Lesions
A fair-skinned patient has 20 actinic keratoses on the balding scalp. You treat all with liquid nitrogen.
Codes:
- 17004 (destruction of 15 or more premalignant lesions)
Do not bill 17000 or 17003. 17004 is all-inclusive for that session.
Scenario 5: Shave Biopsy of Seborrheic Keratosis
A 70-year-old has a 1.2 cm seborrheic keratosis on the chest. You shave it flat and send it to pathology.
Code:
- 11302 (shave removal, 1.1 to 2.0 cm)
Do not use 17110 because you sent the specimen. Do not use 11400 because this is a shave, not an elliptical excision.
Common Billing Mistakes and How to Avoid Them
Even experienced dermatologists and coders make errors. Here are the most frequent mistakes and simple fixes.
| Mistake | Consequence | Fix |
|---|---|---|
| Measuring lesion only, not excised diameter | Under-coding (lost revenue) or over-coding (audit risk) | Document “total excised diameter = X cm” |
| Billing destruction (17000) with biopsy on same lesion | Denial or recoupment | Pick one procedure per lesion per session |
| Forgetting modifier -25 on E/M with minor procedure | E/M bundled into procedure (no pay) | Append -25 and document separate work |
| Billing 17003 as a standalone code | Automatic denial | Always bill 17000 first, then 17003 |
| Using excision codes (11400) for shave biopsy | Over-coding, audit risk | Use 11300-11313 for shave with pathology |
| Not documenting number of lesions for destruction | Down-coding or denial | Count and document each lesion |
| Billing repair with simple linear closure | Denial (repair included in excision) | Only bill repair for intermediate or complex closure |
How Payer Policies Differ
Medicare, Medicaid, and commercial payers do not always follow the same rules. You must know your local coverage determinations (LCDs) for dermatology.
Medicare often has specific requirements for:
- Mohs surgery – Only covered for certain tumor types and locations.
- Multiple procedures – May apply a multiple procedure payment reduction.
- Actinic keratosis destruction – Covers 17000-17004 but may limit frequency.
Commercial payers (UnitedHealthcare, Cigna, Aetna, Blue Cross) may have their own coding edits. Some require modifier -51. Others forbid it. Some cover shave removals (11300) only if pathology is performed.
Medicaid varies state by state. Some states have separate fee schedules and specific prior authorization requirements for excisions.
Always check the payer’s medical policy before performing extensive procedures.
Telehealth and Virtual Dermatology Codes
Telehealth has grown rapidly in dermatology. While store-and-forward telederm is common, CPT codes for live video visits look similar to office E/M codes.
For live video (synchronous) dermatology visits:
- 99202-99215 with modifier -95 (synchronous telemedicine)
Medicare and many payers reimburse these at the same rate as in-person visits, but only for certain visit types. Not all procedures can be done virtually. You cannot bill a biopsy or excision via telehealth.
For store-and-forward (asynchronous) visits, you typically use 99421-99423 (online digital evaluation and management). These pay at lower rates.
Important: Telehealth rules change frequently. After the public health emergency, many temporary flexibilities ended. Check current CMS and private payer policies.
Surgical Trays, Supplies, and Pathology
Do not forget the ancillary codes. While they do not bring high reimbursement, they add up.
- A4550 – Surgical tray (for in-office procedures)
- A4649 – Surgical supply, miscellaneous (for specific dressings or hemostatic agents not otherwise coded)
- 88305 – Pathology, surgical pathology, level IV (this is the lab code for reading a biopsy or excision specimen. The dermatologist does not bill this unless they own the lab. The pathologist bills it.)
If you send a specimen to an external lab, you do not bill 88305. The lab bills it. If you perform Mohs and read your own slides, you use Mohs codes (17311-17315), not separate pathology codes.
Staying Compliant: Audits and Appeals
Dermatology is a frequent target for audits. Medicare’s Targeted Probe and Educate (TPE) program reviews dermatology claims often. Private payers also audit routinely.
To survive an audit:
- Keep complete medical records – No shortcuts.
- Follow NCCI edits – Do not unbundle codes incorrectly.
- Use modifiers appropriately – Especially -25 and -59.
- Do not upcode – Do not bill 99214 when 99213 is correct.
- Do not downcode to avoid review – That loses revenue.
If you receive a denial, appeal. Many denials overturn on first-level appeal with proper documentation. Do not write off a denial without checking if the documentation supports the code.
Resources for Staying Current
CPT codes change every year. The 2026 updates may affect dermatology codes. To stay current:
- Subscribe to the AMA CPT Assistant (monthly newsletter with coding guidance).
- Review CMS NCCI edits quarterly (free online).
- Join the American Academy of Dermatology (AAD) coding and billing webinars.
- Use a reliable coding software (EncoderPro, Find-A-Code, or Optum360).
Do not rely on memory alone. Coding is too complex and changes too fast.
Building a Dermatology Coding Cheat Sheet for Your Practice
Every practice should have a one-page cheat sheet taped near every computer. Here is a template:
Quick Reference: Dermatologist CPT Codes
E/M Established Patient
- 99212 – Straightforward (10-19 min)
- 99213 – Low (20-29 min) – most common
- 99214 – Moderate (30-39 min)
- 99215 – High (40-54 min)
E/M New Patient
- 99202 – Straightforward (15-29 min)
- 99203 – Low (30-44 min)
- 99204 – Moderate (45-59 min)
- 99205 – High (60-74 min)
Biopsies
- 11102 – Shave biopsy
- 11104 – Punch biopsy
- 11106 – Incisional biopsy
Destruction
- 17000 + 17003 – AK, 2-14 lesions
- 17004 – AK, 15+ lesions
- 17110 – Benign, up to 14
- 17111 – Benign, 15+
Excision (Benign – 11400 series)
- 11400 (≤0.6 cm), 11401 (0.7-1.0 cm), 11402 (1.1-2.0 cm)
Excision (Malignant – 11600 series)
- 11600 (≤0.6 cm), 11601 (0.7-1.0 cm), 11602 (1.1-2.0 cm)
Shave with Path (11300 series)
- Based on diameter: 11300 (≤0.5 cm) up to 11306 (>3.0 cm)
Repairs
- Simple – included in excision (do not bill separate)
- Intermediate – 12031-12057
- Complex – 13100-13153
Modifiers
- -25 (separate E/M)
- -59 (distinct procedure)
- -58 (staged procedure)
The Future of Dermatology Coding
Coding will not become simpler. It evolves. The AMA tries to reduce administrative burden, but payers add more rules.
In 2026 and beyond, expect more focus on:
- Value-based coding – Tying codes to outcomes, not just work.
- Artificial intelligence – AI-assisted coding from clinical notes.
- More specific lesion codes – Perhaps by body region.
- Continued telehealth integration – Delayed but coming.
Your best strategy is to learn the current rules well and adapt as they change.
Conclusion (Three-Line Summary)
Dermatologist CPT codes cover everything from a simple office visit (99213) to complex Mohs surgery (17311-17315). The key to correct coding is matching documentation to the precise code: measure excised diameter, not lesion size, and know when to use destruction versus shave versus excision. Avoiding common bundling errors and using modifiers correctly will protect your practice from denials and audits while ensuring fair reimbursement.
Frequently Asked Questions (FAQ)
1. What is the most common dermatologist CPT code?
99213 (established patient office visit, low medical decision making) is the most frequently billed E/M code in dermatology. For procedures, 17000 (destruction of first actinic keratosis) and 17110 (benign lesion destruction) are very common.
2. What is the CPT code for a skin biopsy by a dermatologist?
For a shave biopsy, use 11102 (first lesion) and 11103 (each additional). For a punch biopsy, use 11104 (first lesion) and 11105 (each additional). For an incisional biopsy, use 11106 (first) and 11107 (each additional).
3. Can I bill an office visit and a procedure on the same day?
Yes, but you must add modifier -25 to the office visit code and document that the visit was significantly separate from the procedure work. For example, a rash evaluation (E/M) plus a wart freeze (17110) qualifies with proper documentation.
4. What is the difference between 17000 and 17110?
17000 is for premalignant lesions (actinic keratoses). 17110 is for benign lesions (warts, seborrheic keratoses, skin tags). Do not mix them on the same claim for the same lesion.
5. What is the CPT code for removing a cyst?
For an excised cyst (complete removal), use the benign excision codes 11400-11406 based on the total excised diameter. For an infected cyst with incision and drainage only (no excision), use 10060 (simple) or 10061 (complex).
6. Do I need a different code for a mole removal on the face versus the back?
For excision codes (11400-11646) and shave codes (11300-11306), the codes do not differentiate by anatomic site except for the largest shave sizes (11305 for scalp/neck/hands/feet/genitalia and 11306 for other sites). For repairs (12001-12057), location matters.
7. How do I bill for freezing multiple warts?
If the warts are benign (common warts, flat warts), use 17110 for up to 14 lesions. If 15 or more, use 17111. Document the number and location of each wart.
8. Can I bill a biopsy code if I take a shave and send it to pathology?
Yes. 11102 (tangential biopsy) is the correct code for a diagnostic shave biopsy where tissue goes to pathology. Do not use 17110 (destruction) because that code assumes no specimen is sent.
9. What happens if I use the wrong CPT code?
The claim may deny, pay incorrectly (too much or too little), or trigger an audit. If the payer pays too much and later audits, you must repay the overpayment plus potential penalties. Always verify codes before billing.
10. Where can I find the official list of dermatology CPT codes?
The official source is the AMA’s CPT manual, updated annually. You can also use the CMS website for NCCI edits and LCDs. Your billing software should have the most current codes.
Additional Resource Link
CMS National Correct Coding Initiative (NCCI) Edits – Quarterly Downloads
https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-tools
This free official resource from the Centers for Medicare & Medicaid Services provides quarterly procedure-to-procedure (PTP) edits and medically unlikely edits (MUEs). Always check here before billing two codes together to avoid automatic denials.
