Dermatology Billing Services
Dermatology billing has one structural problem and one commercial one. The structural problem is reconciliation. A single visit can produce several lesions, several techniques, several specimen containers and several pathology reports, and the claim only holds together if the procedure line, the specimen and the diagnosis on the pathology report describe the same lesion. Count the lesions one way and the containers another and the encounter is either short-billed or unsupported on review — the same defect, pointing in two directions. The commercial problem is scope: the same procedure is a covered medical service or a non-covered cosmetic one depending on the indication, and that call has to be made and written down before the encounter is closed rather than after a denial arrives. That is the work we take on. We reconcile lesion counts, container counts and pathology reports against the claim before it is submitted; we select biopsy codes by technique rather than by count; we code Mohs by region, stage and block from the operative report and keep the biopsy and the pathology off the Mohs claim where the rules already include them; and we read the individual plan's policy on Mohs coverage, phototherapy indications and biologic benefit routing rather than working from a stored rule. Code descriptors, bundling rules and drug-to-HCPCS mappings on this page were verified against CMS's CY2026 physician fee schedule relative value file, the 2026 NCCI Policy Manual and CMS's October 2026 HCPCS alphanumeric file on 17 September 2026.
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What Is Dermatology Billing?
Dermatology billing is the specialty discipline of reconciling what was done to what was sent to pathology to what goes on the claim, and of separating covered medical work from non-covered cosmetic work before the encounter closes. We run that reconciliation as the standing job rather than as an answer to a records request: the number of procedure lines, the number of specimen containers and the number of pathology reports have to agree before a claim leaves, because that is what a reviewer checks first and a miscount reads the same in both directions. Around it we take on the specialty's coding work in full. We pick biopsy codes by technique — tangential, punch or incisional — with the matching each-additional code for every further lesion, rather than by lesion count alone. We code Mohs by region, by stage and by tissue block off the operative report, bill the same-day repair, graft or flap separately where the rules allow it, and keep the diagnostic biopsy and the pathology off the Mohs claim unless that biopsy preceded the decision to operate and carries the distinguishing modifier. We size destruction and excision lines by lesion count and by narrowest margin, with benign-versus-malignant diagnosis discipline. We keep the three phototherapy services distinct from the excimer laser family and pair each session to the dermatologic diagnosis and failed-topical-therapy documentation that plan's own policy asks for. We take biologic drug codes from the current CMS HCPCS file rather than from memory, and confirm whether the plan covers the drug under the medical benefit at all before the vial is ordered. On a same-day evaluation plus minor procedure we review the note behind the modifier before submission: the test is not a second diagnosis, it is whether the note shows evaluative work that would still have been done had no lesion been treated. The code table further down this page shows the CY2026 Medicare national unadjusted non-facility amount for each code — total RVU from CMS's published relative value file multiplied by the CY2026 non-qualifying-APM conversion factor of $33.4009 — not an average across payers and not a quote. Your own contracted rates will differ, and a code Medicare does not cover is shown blank.
- Procedure line, specimen container and pathology report must describe the same lesion
- Mohs 17311/17312 head-neck-hands-feet-genitalia; 17313/17314 trunk-arms-legs; 17315 extra block
- NCCI: the Mohs codes already include the biopsy and the pathology — do not bill them again
- Modifier 25 does not need a different diagnosis — it needs work beyond the decision to operate
Who This Page Is For
Common Billing Friction in Dermatology
Modifier 25 on same-day E/M and minor procedure — and the myth about it
Almost every dermatology encounter is an E/M plus a minor procedure, so modifier 25 is where the money and the audit risk both sit. The rule is narrower than the folklore. The 2026 NCCI Policy Manual, chapter I, states that where a procedure carries a 000- or 010-day global period, “the decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service,” and that a significant, separately identifiable E/M “unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.” In the same paragraph it states that “[t]he E&M service and minor surgical procedure do not require different diagnoses,” and that a patient being new “is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.” So the documentation test is not a second diagnosis and not a second chief complaint. It is whether the note shows evaluative work that would still have been done had no lesion been treated. We have not found a payer that publishes a modifier-25 frequency threshold, and we do not quote one; what we do is review the notes behind the modifier before the claim goes out. (NCCI Policy Manual chapter I, revision date 1 January 2026, verified 17 September 2026.)
Biopsy technique selection, add-on stacking, and the destruction edit
Skin biopsy is coded by technique, not by count alone: tangential on 11102 with 11103 for each separate or additional lesion, punch on 11104 with 11105, incisional on 11106 with 11107. Get the technique wrong and the claim is wrong even when the number of lesions is right. The edit that catches most practices is the destruction pair. The 2026 NCCI Policy Manual, chapter III, records that the PTP edits pairing 11102, 11104 and 11106 each with 17000 and 17004 “are often bypassed by using modifier 59 or XE or XS,” and that such use “is only appropriate if the 2 procedures of a code pair edit are performed on separate lesions or at separate patient encounters.” Note what the test is: separate lesions, not separate anatomic regions. A biopsy and a destruction of the same lesion is one service however far apart on the body chart it is documented. The pair-level edit table itself is published by CMS under an AMA licence and is not freely retrievable, so we quote the policy manual rather than the table. (Verified 17 September 2026.)
Mohs: region, stage, block — and what the Mohs codes already include
Mohs is coded by region and by stage. CMS's CY2026 relative value file describes 17311 as the first stage of Mohs on the head, neck, hands, feet and genitalia and 17312 as each additional stage in that family; 17313 as the first stage on the trunk, arms and legs and 17314 as each additional stage in that family; and 17315 as the each-additional-block code. 17314 is a stage code, not a block code, and confusing the two is a Mohs coding error to avoid. The larger trap is what the Mohs codes already contain. The 2026 NCCI Policy Manual, chapter III, states that “[t]he Mohs micrographic surgery CPT codes include skin biopsy and excision services (CPT codes 11102-11107, 11600-11646, and 17260-17286) and pathology services (88300-88309, 88329-88332). Reporting these latter codes in addition to the Mohs micrographic surgery CPT codes is inappropriate.” The exception is documented: where a suspected cancer was biopsied for diagnosis before the decision to proceed, “the biopsy … and frozen section pathology … may be reported separately using modifier 59 or XS or XU, or 58 to distinguish the diagnostic biopsy from the definitive Mohs surgery.” Repairs, grafts and flaps are separately reportable with Mohs. The operative report has to make the stage count and the block count legible, because that is what a reviewer reconciles against. (Verified 17 September 2026.)
Provider-administered biologics: the HCPCS mapping, and the buy-and-bill decision
Dermatology biologic claims fail most often on the drug code itself, and the mappings in circulation are frequently wrong. Verified against CMS's October 2026 HCPCS alphanumeric file: J1628 is guselkumab (Tremfya), J2327 is intravenous risankizumab-rzaa (Skyrizi), J3247 is intravenous secukinumab (Cosentyx), J3245 is tildrakizumab (Ilumya). Dupilumab (Dupixent) has no Level II code in that file, so a provider-administered dose is reported on J3590, unclassified biologics, with the NDC — which is correct practice, not a workaround. Three codes that get misquoted for these drugs belong to something else entirely: J2796 is romiplostim, J2326 is nusinersen, and J3245 is tildrakizumab rather than secukinumab. Separately from the code: most of these products are also dispensed as self-administered pens under the pharmacy benefit, in which case the practice bills nothing for the drug. Buy-and-bill only applies where the plan covers the drug under the medical benefit and does not mandate specialty-pharmacy distribution, and that is a per-plan question to be answered before the vial is ordered rather than after. We do not publish a dollar figure for inventory exposure because it depends entirely on the product, the dose and the acquisition contract.
Phototherapy and patch testing: three different codes, and one medical-necessity gate
Phototherapy is not one service. CMS's CY2026 relative value file describes 96900 as actinotherapy with ultraviolet light, 96910 as photochemotherapy with tar and UVB or petrolatum and UVB, and 96912 as photochemotherapy with psoralens and UVA — PUVA. Published guidance frequently reverses 96910 and 96912; the descriptors above are the ones in the current file. Laser treatment of inflammatory skin disease is a different family again, 96920 through 96922, sized by treated area, and should not be described as phototherapy on a claim or in an appeal. The gate on all of them is indication. Plans pair coverage to a medical dermatologic diagnosis — typically psoriasis, atopic dermatitis or vitiligo — and to documented failure of topical therapy, and the criteria are plan-specific rather than national, so we read the individual policy rather than assume one. Patch testing under 95044 is reported per patch; CMS assigns it PC/TC indicator 5, meaning it is covered incident to the physician's service and neither modifier 26 nor TC applies. We have not found published per-payer unit thresholds for patch testing that we can cite, so we do not quote any.
Dermatology-Specific Payer Issues We Watch For
Modifier 59 versus the X{EPSU} subset
Issue: Payers differ on whether they want the general modifier 59 or the more specific XE/XP/XS/XU subset to bypass a PTP edit, and a claim carrying the one that payer does not prefer can deny even when the underlying services were genuinely distinct
Our approach: We use the more specific modifier where the payer asks for it, and in every case hold to the underlying NCCI test the policy manual states — separate lesions or separate encounters — rather than treating either modifier as a way past an edit. Payer-specific modifier preferences are confirmed against the individual policy, not assumed.
Medicare
Issue: NCCI pairs skin biopsy (11102, 11104, 11106) with destruction of benign or premalignant lesions (17000, 17004); the bypass modifier is only correct when the two services were performed on separate lesions or at separate patient encounters
Our approach: We document the lesion identity behind each line — which lesion was biopsied, which was destroyed — and apply a bypass modifier only where the record shows separate lesions or separate encounters, per the 2026 NCCI Policy Manual chapter III.
Phototherapy and laser (indication gating)
Issue: Plans deny 96900/96910/96912 phototherapy, and the separate 96920–96922 laser family, as cosmetic when the claim does not carry a medical dermatologic diagnosis and documentation of failed topical therapy; the two families are frequently confused with each other in appeals, which loses the appeal on its own
Our approach: We pair each session to the specific dermatologic ICD-10 code and the chart note recording the indication and the treatment protocol, and we appeal under the correct family — phototherapy or laser — against that plan's own published criteria.
Commercial plans (Mohs coverage criteria)
Issue: Mohs coverage criteria are set per plan by tumour type, histology and anatomic site rather than nationally, so a case that clears at one payer is denied at another for the same tumour
Our approach: We read the individual plan's Mohs policy before the procedure is scheduled and confirm the tumour type and site fall inside it, flagging cases where standard excision is the covered route. We do not publish a site list here, because it is plan-specific and changes.
What We Handle
Mohs surgery — region-coded stages, repair sequencing, and slide reconciliation
Region-correct and stage-correct Mohs coding — 17311 with 17312 for head, neck, hands, feet and genitalia; 17313 with 17314 for trunk, arms and legs; 17315 for each additional tissue block — with same-day repair billed across the intermediate and complex closure ranges, which NCCI confirms are separately reportable with Mohs. We reconcile the stage and block counts in the operative report against the claim before it goes out, and we do not bill the diagnostic biopsy or the pathology alongside Mohs unless the biopsy preceded the decision to operate and carries the distinguishing modifier.
Skin biopsies — the 11102–11107 technique family and add-on stacking
Technique-correct primary code selection across tangential (11102), punch (11104) and incisional (11106) biopsy, with the matching each-additional add-ons (11103, 11105, 11107) and specimen-to-procedure reconciliation so the number of lesions on the claim, the number of containers sent and the number of pathology reports returned all agree. Dermatopathology (88305) is billed with these biopsies where the practice performs or bills the reading — but never alongside Mohs, where NCCI treats the pathology as already included.
Phototherapy and laser — 96900/96910/96912 and 96920–96922, correctly separated
Session billing for actinotherapy with UV light (96900), photochemotherapy with tar or petrolatum plus UVB (96910) and PUVA (96912), kept distinct from excimer laser treatment of inflammatory skin disease (96920–96922), which is sized by treated area and is a separate family. Each is paired to the medical diagnosis and the failed-topical-therapy documentation the individual plan policy asks for, with treatment-frequency tracking against that policy's own limits.
Destruction and excision coding — 17000 series and 11400/11600 sizing rules
Destruction billing for premalignant lesions (17000 first, 17003 for 2–14, 17004 for 15+), with benign excision coding across 11400–11471 and malignant across 11600–11646. Lesion sizing in 0.5 cm increments to narrowest excision margin, body-region specific, with D23.x versus C44.x diagnosis discipline.
Biologic HCPCS coding — correct drug-to-code mapping and the benefit-side routing
Drug codes taken from the current CMS HCPCS alphanumeric file rather than from memory: J1628 guselkumab, J2327 intravenous risankizumab-rzaa, J3247 intravenous secukinumab, J3245 tildrakizumab, and J3590 with the NDC for dupilumab and anything else without a specific Level II code. Payment for these is average sales price based and republished quarterly, so we reconcile against the current file rather than a stored fee. Before the vial is ordered we confirm whether the plan covers the drug under the medical benefit at all or routes it to a specialty pharmacy.
Teledermatology — 95 modifier, POS 02 vs 10, and store-and-forward billing
Teledermatology billing with modifier 95, place of service 10 for the patient's home and 02 for other non-home telehealth, plus store-and-forward asynchronous review under the individual plan's policy. Telehealth coverage and place-of-service rules have moved repeatedly, so we check the current payer policy at the time of service rather than working from a stored rule.
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Key Dermatology CPT Codes
| CPT Code | Description | Medicare Amount CY2026 national, non-facility |
|---|---|---|
| 17311 | Mohs, first stage, head/neck/hands/feet/genitalia, up to 5 blocks | $667 |
| 17312 | Mohs, each additional stage (17311 family), up to 5 blocks | $403 |
| 11102 | Tangential biopsy of skin, single lesion | $96 |
| 11104 | Punch biopsy of skin, single lesion | $121 |
| 17000 | Destruction of premalignant lesion, first lesion | $66 |
| 17003 | Destruction of premalignant lesion, each 2nd through 14th | $6 |
| 11600 | Excision of malignant lesion, trunk, arms, or legs, 0.5 cm or less | $198 |
| 96920 | Laser treatment, inflammatory skin disease, under 250 sq cm | $138 |
Amounts are the Medicare national unadjusted non-facility amounts for CY2026, computed from the published CMS relative value file. They are not what a commercial payer pays, and your locality adjustment moves them. A dash means Medicare publishes no amount for that code — because it is non-covered, bundled, or priced outside the fee schedule.
Why General Billing Teams Miss Dermatology Issues
General billing staff handle dozens of specialties and rarely develop the depth needed for dermatology coding nuances. Here is what gets missed.
Modifier and bundling errors
Specialty-specific modifier rules and CCI edits are frequently overlooked by teams that do not work exclusively in dermatology.
Under-coding high-complexity visits
Dermatology encounters often qualify for higher-level E/M codes, but generalist billers default to mid-level codes to avoid audit risk.
Missed payer-specific rules
Each payer has unique coverage and documentation requirements for dermatology procedures that general teams rarely memorize.
Slow denial turnaround
Without specialty knowledge, appeal letters lack the clinical specificity needed to overturn dermatology denials quickly.
“The dermatology leak people look for is Mohs. The one that actually recurs is the daily reconciliation between what was done, what was sent to pathology and what went on the claim. Here is the shape of it, as an illustration with our own arithmetic rather than a survey figure: at the CY2026 Medicare national non-facility amount for 11102 — about $96 — a practice doing 400 tangential biopsies a month bills roughly $38,000 on that one code. If the lesion count and the container count disagree on five per cent of those visits, that is twenty lesions, about $1,900 a month, and the same five per cent is also the audit exposure, because a miscount reads identically in both directions. The percentage is the number to measure in your own data; we have not seen a published benchmark for it and do not quote one.”
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Dermatology Coding Expert
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Dermatology Billing Terms
- Mohs Micrographic Surgery
- A staged technique for removing skin cancer in which one physician performs both the surgery and the microscopic examination of each stage before proceeding. Coded by region and stage — 17311 with 17312 for head, neck, hands, feet and genitalia, 17313 with 17314 for trunk, arms and legs — with 17315, and only 17315, for each additional tissue block. Per the 2026 NCCI Policy Manual the Mohs codes already include the biopsy, the excision and the pathology services.
- Modifier 59 / XS
- Modifiers indicating a distinct procedural service. In dermatology they are used where a biopsy and a destruction, or two procedures otherwise paired by an NCCI edit, were genuinely separate. The 2026 NCCI Policy Manual limits that use to services performed on separate lesions or at separate patient encounters — lesion identity, not body region, is the test.
- Tangential Biopsy (Shave)
- A biopsy technique where a thin layer of tissue is removed using a horizontal cut. Coded as 11102 for the first lesion and 11103 for each additional. Different from punch biopsy in technique, coding, and reimbursement.
- Destruction of Premalignant Lesion
- Removal of precancerous growths (actinic keratoses) using cryotherapy, electrodesiccation, or chemical agents. The first lesion is coded with 17000 and each additional lesion (2-14) with 17003. Lesions beyond 14 use 17004.
- Complex Repair
- Wound closure requiring more than a layered closure, such as scar revision, debridement or extensive undermining. Billed separately from the Mohs excision using the repair codes for the anatomic site and length; the 2026 NCCI Policy Manual states that repairs, grafts and flaps are separately reportable with the Mohs codes, and that wound repair codes are not reportable with excision of benign lesions of 0.5 cm or less.
- Pathology Specimen Coordination
- Matching every biopsy or excision line on the claim to its own specimen container and its own pathology report. When the number of procedure lines, containers and reports disagree, the encounter is either short-billed or unsupported on review — which is why the reconciliation runs before submission rather than after a records request.
Last updated: 2026-09-17
Common Questions
Common questions about dermatology billing services.
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Request ReviewHow do you bill for Mohs surgery with multiple stages?
By region first, then by stage, then by block. Per CMS's CY2026 relative value file, 17311 is the first stage on the head, neck, hands, feet or genitalia and 17312 is each additional stage in that family; 17313 is the first stage on the trunk, arms or legs and 17314 is each additional stage in that family. 17315 — not 17314 — is the each-additional-block code. Repairs are billed separately: the 2026 NCCI Policy Manual states that “[r]epairs, grafts, and flaps are separately reportable with the Mohs micrographic surgery CPT codes.” The biopsy and the pathology are not: the same chapter states that the Mohs codes “include skin biopsy and excision services … and pathology services” and that reporting those alongside Mohs “is inappropriate,” unless a diagnostic biopsy preceded the decision to proceed and is distinguished with modifier 59, XS, XU or 58. We reconcile stage and block counts in the operative report against the claim before submission.
How do you handle cosmetic procedures that are also medically necessary?
By deciding it before the encounter closes, not after the denial. Where a procedure has both a medical indication and a cosmetic effect, the medically necessary portion is billed to the plan with the diagnosis and the functional or clinical findings that support it, and the cosmetic portion is quoted and collected from the patient as a separate, disclosed charge. The part that protects the practice is sequencing: the patient is told which portion is theirs before treatment, and the note records the medical indication in its own right rather than as a justification written afterwards.
Can multiple biopsies be billed on the same day?
Yes, and the count has to reconcile three ways. The first lesion is billed with the primary code for the technique used (11102 tangential, 11104 punch, 11106 incisional) and each separate or additional lesion with the matching add-on (11103, 11105, 11107). Each lesion needs its own container and its own pathology report, and the number of procedure lines, containers and reports must agree — that reconciliation is what a reviewer checks first. Where a biopsy and a destruction happen at the same visit, the 2026 NCCI Policy Manual allows the edit to be bypassed with modifier 59, XE or XS “only … if the 2 procedures of a code pair edit are performed on separate lesions or at separate patient encounters.” Separate lesions, not separate regions.
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