Medicare Benefits Schedule - Note TN.8.7

Needle aspiration biopsy attracts benefits on an attendance basis and not under item 30078. 

Item 30071 (diagnostic biopsy of the skin) or 30072 (diagnostic biopsy of mucous membrane) should be used when a biopsy (including shave) of a lesion is required to confirm a diagnosis and would facilitate the appropriate management of that lesion. If the shave biopsy results in a definitive excision of the lesion, only 30071 or 30072 can be claimed. 

Items 30071-30094 and 30820 require that the specimen be sent for pathological examination. 

The aftercare period for item 30071 or 30072 is 2 days rather than the standard aftercare period for skin excision of 10 days.

Related Items: 30071 30072 30078 30081 30084 30087 30090 30093 30094 30820

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Multiple Operation Rule

Diagnostic biopsy of skin, as an independent procedure, if the biopsy specimen is sent for pathological examination

(Anaes.)

Fee: $57.50 Benefit: 75% = $43.15 85% = $48.90

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

Diagnostic biopsy of mucous membrane, as an independent procedure, if the biopsy specimen is sent for pathological examination

(Anaes.)

Fee: $57.50 Benefit: 75% = $43.15 85% = $48.90

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC DRILL BIOPSY OF LYMPH NODE, DEEP TISSUE OR ORGAN, as an independent procedure, where the biopsy specimen is sent for pathological examination

(Anaes.)

Fee: $53.35 Benefit: 75% = $40.05 85% = $45.35

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC BIOPSY OF BONE MARROW by trephine using open approach, where the biopsy specimen is sent for pathological examination

(Anaes.)

Fee: $120.95 Benefit: 75% = $90.75 85% = $102.85

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC BIOPSY OF BONE MARROW by trephine using percutaneous approach where the biopsy is sent for pathological examination

(Anaes.)

Fee: $64.75 Benefit: 75% = $48.60 85% = $55.05

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC BIOPSY OF BONE MARROW by aspiration or PUNCH BIOPSY OF SYNOVIAL MEMBRANE, where the biopsy is sent for pathological examination

(Anaes.)

Fee: $32.35 Benefit: 75% = $24.30 85% = $27.50

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC BIOPSY OF PLEURA, PERCUTANEOUS 1 or more biopsies on any 1 occasion, where the biopsy is sent for pathological examination

(Anaes.)

Fee: $141.50 Benefit: 75% = $106.15 85% = $120.30

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC NEEDLE BIOPSY OF VERTEBRA, where the biopsy is sent for pathological examination

(Anaes.)

Fee: $188.85 Benefit: 75% = $141.65 85% = $160.55

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

DIAGNOSTIC PERCUTANEOUS ASPIRATION BIOPSY of deep organ using interventional imaging techniques - but not including imaging, where the biopsy is sent for pathological examination

(Anaes.)

Fee: $208.50 Benefit: 75% = $156.40 85% = $177.25

(See para TN.8.7 of explanatory notes to this Category)

Multiple Operation Rule

Lymph node of neck, biopsy of, by open procedure, if the specimen excised is sent for pathological examination

(Anaes.)

Fee: $202.40 Benefit: 75% = $151.80 85% = $172.05

(See para TN.8.7 of explanatory notes to this Category)