Medicare Benefits Schedule - Note TN.8.22

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.22

Removal of Skin Lesions - (Items 31356 to 31376)

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 suspicious pigmented lesions for diagnostic purposes attract benefits under items 31357, 31360, 31362, 31364, 31366, 31368 and 31370. 

Malignant tumours are covered by items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369 and 31371 to 31376. 

Items 31357, 31360, 31362, 31364, 31366, 31368, 31370 require that the specimen be sent for histological examination. Items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371-31376 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. 

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

It will be necessary for practitioners to 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 31375 31376


Related Items

Category 3 - THERAPEUTIC PROCEDURES

31356

31356 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $234.00 Benefit: 75% = $175.50 85% = $198.90

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

Category 3 - THERAPEUTIC PROCEDURES

31357

31357 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $115.95 Benefit: 75% = $87.00 85% = $98.60

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

Category 3 - THERAPEUTIC PROCEDURES

31358

31358 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $286.35 Benefit: 75% = $214.80 85% = $243.40

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

Category 3 - THERAPEUTIC PROCEDURES

31359

31359 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $349.05 Benefit: 75% = $261.80

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

Category 3 - THERAPEUTIC PROCEDURES

31360

31360 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $177.65 Benefit: 75% = $133.25 85% = $151.05

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

Category 3 - THERAPEUTIC PROCEDURES

31361

31361 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $197.40 Benefit: 75% = $148.05 85% = $167.80

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

Category 3 - THERAPEUTIC PROCEDURES

31362

31362 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $141.60 Benefit: 75% = $106.20 85% = $120.40

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

Category 3 - THERAPEUTIC PROCEDURES

31363

31363 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $258.20 Benefit: 75% = $193.65 85% = $219.50

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

Category 3 - THERAPEUTIC PROCEDURES

31364

31364 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $177.65 Benefit: 75% = $133.25 85% = $151.05

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

Category 3 - THERAPEUTIC PROCEDURES

31365

31365 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31369, 31370, 31371, 31372 or 31373), 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: $167.35 Benefit: 75% = $125.55 85% = $142.25

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

Category 3 - THERAPEUTIC PROCEDURES

31366

31366 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $100.95 Benefit: 75% = $75.75 85% = $85.85

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

Category 3 - THERAPEUTIC PROCEDURES

31367

31367 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $225.80 Benefit: 75% = $169.35 85% = $191.95

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

Category 3 - THERAPEUTIC PROCEDURES

31368

31368 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $132.70 Benefit: 75% = $99.55 85% = $112.80

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

Category 3 - THERAPEUTIC PROCEDURES

31369

31369 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), 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: $260.00 Benefit: 75% = $195.00 85% = $221.00

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

Category 3 - THERAPEUTIC PROCEDURES

31370

31370 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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: $151.80 Benefit: 75% = $113.85 85% = $129.05

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

Category 3 - THERAPEUTIC PROCEDURES

31371

31371 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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, 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: $377.40 Benefit: 75% = $283.05 85% = $320.80

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

Category 3 - THERAPEUTIC PROCEDURES

31372

31372 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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, 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 item 45201

(Anaes.)

Fee: $326.35 Benefit: 75% = $244.80 85% = $277.40

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

Category 3 - THERAPEUTIC PROCEDURES

31373

31373 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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, 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: $377.20 Benefit: 75% = $282.90 85% = $320.65

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

Category 3 - THERAPEUTIC PROCEDURES

31375

31375 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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, 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 item 45201

(Anaes.)

Fee: $320.70 Benefit: 75% = $240.55 85% = $272.60

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

Category 3 - THERAPEUTIC PROCEDURES

31376

31376 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2016
Schedule Fee Updated:
01-Jul-2022

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, 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: $371.70 Benefit: 75% = $278.80 85% = $315.95

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


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change