Medicare Benefits Schedule - Note TN.8.274

Only one item can be claimed from the excision of burnt tissue items (items 46101 to 46111) for one provider in one operation.

Item 46112, for excision of burnt tissue involving whole of face, may be claimed with one excision of burnt tissue item (items 46101 to 46111), based on the percentage of total body surface (excluding the face).

For any size of burn, each surgeon can work with another surgeon and each surgeon chooses the excision item from items 46101 to 46112 based on the area that they, as an individual surgeon, have excised.

Where two surgeons are claiming item numbers, the sum of items of each of the surgeons should match the total percentage surface area of burn excised for that patient.

Excision of burnt tissue items (items 46101 to 46112) can be co-claimed with immediate closure items (items 46113 to 46124), but not with delayed definitive closure items (items 46130 to 46136).

When immediate closure is being performed, if it is indicated, both an immediate closure item (items 46113 to 46124) and a non-excisional debridement item (items 46125 to 46129) can be claimed.

Delayed definitive closure items (items 46130 to 46136) cannot be co-claimed with excision of burnt tissue items (items 46101 to 46112), immediate closure items (items 46113 to 46124) or non-excisional debridement items (items 46125 to 46129).

The modifier item (46100) can be co-claimed with the excision of burnt tissue items, immediate closure items, the non-excisional debridement items and the delayed closure items, but it cannot to co-claimed with whole-of-face items 46112, 46124 or 46136.

Related Items: 46100 46101 46102 46103 46104 46105 46106 46107 46108 46109 46110 46111 46112 46113 46114 46115 46116 46117 46118 46119 46120 46121 46122 46123 46124 46125 46126 46127 46128 46129 46130 46131 46132 46133 46134 46135 46136

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Multiple Operation Rule

Excision of burnt tissue, or definitive burn wound closure, if:
(a) the area of burn excised involves more than 1% of hands, face or anterior neck; and
(b) the service is performed in conjunction with a service (the co-claimed service) to which any of items 46101 to 46135 (other than item 46112 or 46124) apply;
other than a service to which item 46136 applies

40% of the fee for the co-claimed service - performed in conjunction with a service (the co-claimed service) to which any of items 46101 to 46135 (other than item 46112 or 46124) apply.

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves not more than 1% of the total body surface

(Anaes.) (Assist.)

Fee: $393.75 Benefit: 75% = $295.35 85% = $334.70

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves more than 1% but less than 3% of the total body surface (H)

(Anaes.) (Assist.)

Fee: $625.05 Benefit: 75% = $468.80

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 3% or more but less than 10% of the total body surface (H)

(Anaes.) (Assist.)

Fee: $685.55 Benefit: 75% = $514.20

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 10% or more but less than 20% of the total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,045.90 Benefit: 75% = $784.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 20% or more but less than 30% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,406.60 Benefit: 75% = $1,054.95

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 30% or more but less than 40% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,767.95 Benefit: 75% = $1,326.00

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 40% or more but less than 50% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,128.65 Benefit: 75% = $1,596.50

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 50% or more but less than 60% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,488.75 Benefit: 75% = $1,866.60

(See para TN.8.273, TN.8.274, TN.8.275 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 60% or more but less than 70% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,849.50 Benefit: 75% = $2,137.15

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 70% or more but less than 80% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,246.60 Benefit: 75% = $2,434.95

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves 80% or more of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,635.95 Benefit: 75% = $2,727.00

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excision of burnt tissue, if the area of burn excised involves whole of face (excluding ears)—may be claimed with any one of items 46101 to 46111, based on the percentage total body surface (excluding the face), other than a service associated with a service to which item 46100 applies and excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,007.25 Benefit: 75% = $1,505.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, or closure of skin defect secondary to burns contracture release, if the defect area is not more than 1% of total body surface and if the service:

(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and

(b) involves:

    (i) autologous skin grafting for definitive closure; or

    (ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $393.75 Benefit: 75% = $295.35

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, or closure of skin defect secondary to burns contracture release, if the defect area is more than 1% but not more than 3% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $625.05 Benefit: 75% = $468.80

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, if the defect area is more than 3% but not more than 10% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

(H)

(Anaes.) (Assist.)

Fee: $685.55 Benefit: 75% = $514.20

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, if the defect area is more than 10% but less than 20% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision or contracture release; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,045.90 Benefit: 75% = $784.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 20% or more but less than 30% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,406.60 Benefit: 75% = $1,054.95

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 30% or more but less than 40% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,767.95 Benefit: 75% = $1,326.00

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 40% or more but less than 50% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,128.65 Benefit: 75% = $1,596.50

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 50% or more but less than 60% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,488.75 Benefit: 75% = $1,866.60

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 60% or more but less than 70% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,849.50 Benefit: 75% = $2,137.15

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 70% or more but less than 80% of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,246.60 Benefit: 75% = $2,434.95

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, if the defect area is 80% or more of total body surface and if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,635.95 Benefit: 75% = $2,727.00

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure of whole of face, if the service:
(a) is performed at the same time as the procedure for the primary burn wound excision; and
(b) involves:

(i) autologous skin grafting for definitive closure; or
(ii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare, other than a service associated with a service to which item 46100 applies (H)

(Anaes.) (Assist.)

Fee: $2,007.25 Benefit: 75% = $1,505.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Non-excisional debridement of superficial or mid-dermal partial thickness burns, if the area of burn involves less than 1% of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements)

(Anaes.) (Assist.)

Fee: $393.75 Benefit: 75% = $295.35 85% = $334.70

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Non‑excisional debridement of superficial or mid‑dermal partial thickness burns, if the area of burn involves 1% or more but less than 3% of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements)

(H)

(Anaes.) (Assist.)

Fee: $625.05 Benefit: 75% = $468.80

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Non-excisional debridement of superficial or mid-dermal partial thickness burns, if the area of burn involves 3% or more but less than 10% of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements) (H)

(Anaes.) (Assist.)

Fee: $865.85 Benefit: 75% = $649.40

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Non-excisional debridement of superficial or mid-dermal partial thickness burns, if the area of burn involves 10% or more but less than 30% of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements), excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,587.30 Benefit: 75% = $1,190.50

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Non-excisional debridement of superficial or mid-dermal partial thickness burns, if the area of burn involves 30% or more of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements), excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,904.80 Benefit: 75% = $2,178.60

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, if the defect area involves less than 1% of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non‑autologous temporary wound closure or simple dressings

(H)

(Anaes.) (Assist.)

Fee: $393.75 Benefit: 75% = $295.35

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, if the defect area involves 1% or more but less than 3% of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure or simple dressings (H)

(Anaes.) (Assist.)

Fee: $625.05 Benefit: 75% = $468.80

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, if the defect area involves 3% or more but less than 10% of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure or simple dressings (H)

(Anaes.) (Assist.)

Fee: $685.55 Benefit: 75% = $514.20

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, if the defect area involves 10% or more but less than 20% of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure or simple dressings, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,045.90 Benefit: 75% = $784.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, if the defect area involves 20% or more but less than 30% of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,314.70 Benefit: 75% = $1,736.05

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, if the defect area involves 30% or more of total body surface, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,635.95 Benefit: 75% = $2,727.00

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, of whole of face, using autologous tissue (split skin graft or other) following previous procedure using non-autologous temporary wound closure, excluding aftercare, other than a service associated with a service to which item 46100 applies (H)

(Anaes.) (Assist.)

Fee: $2,007.25 Benefit: 75% = $1,505.45

(See para TN.8.273, TN.8.274 of explanatory notes to this Category)