Medicare Benefits Schedule - Note TN.8.22

The excision of warts and seborrheic keratoses attracts benefits on an attendance basis with the exceptions outlined in TN.8.9 of the explanatory notes to this category. Excision of pre-malignant lesions including solar keratoses where clinically indicated are covered by items 31357, 31360, 31362, 31364, 31366, 31368 and 31370. 

The excision of pigmented lesions which are clinically suspicious for melanoma attracts benefits under items 31377, 31378, 31379, 31380, 31381, 31382 or 31383. 

Excision of malignant tumours are covered by items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371 to 31376, 31386, 31387 and 31388.

Items 31386, 31387 and 31388 should be used for very large, fungating skin cancers.

Items 31357, 31360, 31362, 31364, 31366, 31368, 31370, 31377, 31378, 31379, 31380, 31381, 31382 and 31383 require that the specimen be sent for histological examination. Items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371-31376, 31386, 31387 and 31388 also require that a specimen has been sent for histological confirmation of malignancy, and any subsequent specimens are sent for histological examination. Confirmation of malignancy must be received before itemisation of accounts for Medicare benefits purposes, except in the case of items 31377, 31378, 31379, 31380, 31381, 31382 or 31383.

An incomplete surgical excision of a malignant skin lesion with curative intent should be billed as a malignant skin lesion excision item even when further surgery is needed.

Where histological results are available at the time of issuing accounts, the histological diagnosis will decide the appropriate itemisation for excised lesions. If the histological report shows the lesion to be benign, items 31357, 31360, 31362, 31364, 31366, 31368 or 31370 should be used. 

Practitioners should retain copies of histological reports.

Related Items: 31356 31357 31358 31359 31360 31361 31362 31363 31364 31365 31366 31367 31368 31369 31370 31371 31372 31373 31374 31375 31376 31386 31387 31388

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Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b)     the necessary excision diameter is less than 6 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201

(Anaes.)

Fee: $243.60 Benefit: 75% = $182.70 85% = $207.10

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b)     the necessary excision diameter is less than 6 mm; and

(c)     the excised specimen is sent for histological examination;

not in association with item 45201

(Anaes.)

Fee: $120.70 Benefit: 75% = $90.55 85% = $102.60

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b)     the necessary excision diameter is 6 mm or more; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $298.15 Benefit: 75% = $223.65 85% = $253.45

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision), if:

(a)     the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia (the applicable site); and

(b)     the necessary excision area is at least one third of the surface area of the applicable site; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(H)

(Anaes.)

Fee: $363.40 Benefit: 75% = $272.55

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b)     the necessary excision diameter is 6 mm or more; and

(c)     the excised specimen is sent for histological examination

(Anaes.)

Fee: $184.95 Benefit: 75% = $138.75 85% = $157.25

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the

    knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is less than 14 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201

(Anaes.)

Fee: $205.50 Benefit: 75% = $154.15 85% = $174.70

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the

    knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is less than 14 mm; and

(c)     the excised specimen is sent for histological examination;

not in association with item 45201

(Anaes.)

Fee: $147.45 Benefit: 75% = $110.60 85% = $125.35

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the

    knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is 14 mm or more; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $268.85 Benefit: 75% = $201.65 85% = $228.55

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the

    knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is 14 mm or more; and

(c)     the excised specimen is sent for histological examination

(Anaes.)

Fee: $184.95 Benefit: 75% = $138.75 85% = $157.25

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31369, 31370, 31371, 31372, 31373, 31377, 31378 or 31379), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b)     the necessary excision diameter is less than 15 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201

(Anaes.)

Fee: $174.20 Benefit: 75% = $130.65 85% = $148.10

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b)     the necessary excision diameter is less than 15 mm; and

(c)     the excised specimen is sent for histological examination;

not in association with item 45201

(Anaes.)

Fee: $105.10 Benefit: 75% = $78.85 85% = $89.35

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b)     the necessary excision diameter is at least 15 mm but not more than 30 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201

(Anaes.)

Fee: $235.10 Benefit: 75% = $176.35 85% = $199.85

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b)     the necessary excision diameter is at least 15 mm but not more than 30mm; and

(c)     the excised specimen is sent for histological examination;

not in association with item 45201

(Anaes.)

Fee: $138.20 Benefit: 75% = $103.65 85% = $117.50

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b)     the necessary excision diameter is more than 30 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $270.70 Benefit: 75% = $203.05 85% = $230.10

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Non-malignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a)     the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b)     the necessary excision diameter is more than 30 mm; and

(c)     the excised specimen is sent for histological examination

(Anaes.)

Fee: $158.05 Benefit: 75% = $118.55 85% = $134.35

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b)     the necessary excision diameter is 6 mm or more; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $392.95 Benefit: 75% = $294.75 85% = $334.05

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is less than 14 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with a service to which item 45201 applies

(Anaes.)

Fee: $339.80 Benefit: 75% = $254.85 85% = $288.85

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from face, neck, scalp, nipple-areola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b)     the necessary excision diameter is 14 mm or more; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $392.75 Benefit: 75% = $294.60 85% = $333.85

(See para TN.8.22, TN.8.23, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b)     the necessary excision diameter is less than 15 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with a service to which item 45201 applies

(Anaes.)

Fee: $310.30 Benefit: 75% = $232.75 85% = $263.80

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b)     the necessary excision diameter is at least 15 mm but not more than 30 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy;

not in association with a service to which item 45201 applies

(Anaes.)

Fee: $333.90 Benefit: 75% = $250.45 85% = $283.85

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, including excision of the primary tumour bed, if:

(a)     the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b)     the necessary excision diameter is more than 30 mm; and

(c)     the excised specimen is sent for histological examination; and

(d)     malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

Fee: $387.05 Benefit: 75% = $290.30 85% = $329.00

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:
(a) the lesion is excised from the head or neck; and
(b) the necessary excision diameter is more than 50 mm; and
(c) the excision involves at least 2 critical areas (eyelid, nose, ear, mouth); and
(d) the excised specimen is sent for histological examination; and
(e) malignancy is confirmed from the excised specimen or previous biopsy; and
(f) the service is not covered by item 31387

(H)

(Anaes.) (Assist.)

Fee: $786.45 Benefit: 75% = $589.85

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:
(a) the lesion is excised from the head or neck; and
(b) the necessary excision diameter is more than 70 mm; and
(c) the excised specimen is sent for histological examination; and
(d) malignancy is confirmed from the excised specimen or previous biopsy; and
(e) the service is not covered by item 31386

(H)

(Anaes.) (Assist.)

Fee: $707.70 Benefit: 75% = $530.80

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382 or 31383), surgical excision (other than by shave excision) and repair of, if:
(a) the lesion is excised from the trunk or limbs; and
(b) the necessary excision diameter is more than 120 mm; and
(c) the excised specimen is sent for histological examination; and
(d) malignancy is confirmed from the excised specimen or previous biopsy

(H)

(Anaes.) (Assist.)

Fee: $636.90 Benefit: 75% = $477.70

(See para TN.8.22, TN.8.125 of explanatory notes to this Category)