Use and cost of skin biopsy procedures in the Medicare Part B fee-for-service population, 2017 to 2020

The Center for Medicare and Medicaid Services noted skin biopsies have high expenditures and changed biopsy billing codes in 2018 to better align procedure type and associated billings. We examined associations between billing code updates and skin biopsy utilization and reimbursement across provider specialties. While dermatologists perform most skin biopsies, the proportion of skin biopsies performed by dermatologists has continuously decreased, but the proportion of skin biopsies performed by nonphysician clinicians has increased from 2017-2020. After the code update, the non-facility national payment amount decreased for first tangential biopsy but increased for first punch, first incisional, additional tangential, additional punch and additional incisional biopsy compared to the corresponding amount for first and additional biopsy before the code update. The allowable charges and Medicare payment per skin biopsy increased across provider specialties but has increased the most for primary care physicians from 2018-2020.