Medicare Benefits Schedule - Note TN.8.125

The necessary excision diameter (or defect size) refers to the lesion size plus a clinically appropriate margin of healthy tissue required with the intent of complete surgical excision. Measurements should be taken prior to excision. Margin size should be determined in line with current NHMRC guidelines.  

For the purpose of items 31356 to 31388, the defect size is calculated by the average of the width and the length of the skin lesion and an appropriate margin. The necessary excision diameter is calculated as shown in the Factsheet at this link: Determining lesion size for MBS selection

Practitioners must retain copies of histological reports and any other supporting evidence (patient notes, photographs etc). Photographs should include scale.

An episode of care includes both the excision and closure for the same defect, even when excision and closure occur at separate attendances.

The initial excision of a suspected melanoma may be claimed using item 31377, 31378, 31379, 31380, 31381, 31382 or 31383, depending on the location of the malignancy and the size of the excision diameter. Wide excision of the primary tumour bed following histological confirmation of melanoma, appendageal carcinoma, malignant connective tissue or merkel cell carcinoma of the skin may be claimed using item 31371, 31372, 31373, 31374, 31375 or 31376, depending on the location of the malignancy and the size of the excision diameter.

For items 31356 to 31370, 31386, 31387 and 31388, a malignant skin lesion is defined as a basal cell carcinoma; a squamous cell carcinoma (including keratoacanthoma); a cutaneous deposit of lymphoma; or a cutaneous metastasis from an internal malignancy.

Related Items: 31356 31357 31358 31359 31360 31361 31362 31363 31364 31365 31366 31367 31368 31369 31370 31371 31372 31373 31374 31375 31376 31377 31378 31379 31380 31381 31382 31383 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

Clinically suspected melanoma, 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 a service to which item 45201 applies

(Anaes.)

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

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

Multiple Operation Rule

Clinically suspected melanoma, 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.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Clinically suspected melanoma, 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 a service to which item 45201 applies

(Anaes.)

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

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

Multiple Operation Rule

Clinically suspected melanoma, 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.8.125 of explanatory notes to this Category)

Multiple Operation Rule

Clinically suspected melanoma, 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 31377, 31378, 31379 or 31380; 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 a service to which item 45201 applies

(Anaes.)

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

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

Multiple Operation Rule

Clinically suspected melanoma, 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 31377, 31378, 31379 or 31380; 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;

not in association with a service to which item 45201 applies

(Anaes.)

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

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

Multiple Operation Rule

Clinically suspected melanoma, 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 31377, 31378, 31379 or 31380; 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.8.125 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)