When billing the punch biopsy procedure for Epidermal Nerve Fiber Density Testing it is appropriate to bill CPT code 11100 for the first biopsy. Any additional biopsies performed on the same date of service would require the CPT code 11101. You would then utilize a multiplier for the number of biopsies you performed beyond the first. Since it is billed as a procedure, be aware that certain insurances may not allow a procedure to be added onto an office visit on that same date of service (please consult your insurance providers to verify). However, you could add it on to another procedure with a 59 modifier if one happens to be performed on that same date.