# CPT 11104

> Medicare paid $133.29 for CPT 11104 in the office (non-facility) setting and $48.15 in a facility under the Q3 2021 Physician Fee Schedule, effective July 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it increased 3.5%.

## What it is

A biopsy that uses a small circular cutting tool, like a tiny cookie cutter, to remove a full-thickness plug of skin for the laboratory. Because the sample includes the deeper layers, it shows the pathologist more than a shave sample does. This code covers the first lesion punched at a visit; a companion code handles each further lesion sampled the same way.

## Selected release

- Release: Q3 2021 (2021 C)
- Effective: July 1 – September 30, 2021
- Status indicator: A
- Office (non-facility) national allowed amount: $133.29
- Facility national allowed amount: $48.15
- Sequestration: not applied

## RVUs and formula

- Work RVU: 0.83
- Office (non-facility) practice expense RVU: 2.90
- Facility practice expense RVU: 0.46
- Malpractice RVU: 0.09
- Conversion factor: 34.8931
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q3 2021)
- CMS file: https://www.cms.gov/files/zip/rvu21c-updated-6302021.zip
- Parsed file: PPRRVU21_JUL.csv, row 5,804
- Canonical page: https://localishealth.com/cpt/11104/2021/A
- Release-specific citation URL: https://localishealth.com/cpt/11104/2021/C
- Last significant update: 2026-08-04T03:10:45+00:00