Medicare Benefits Schedule - Note TN.8.23

For the purposes of these items, the face is defined as that portion of the head anterior to the hairline and above the jawline.

Related Items: 31245 31361 31362 31363 31364 31372 31373

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Multiple Operation Rule

Skin and subcutaneous tissue, extensive excision of, in the treatment of suppurative hydradenitis (excision from axilla, groin or natal cleft) or sycosis barbae or nuchae (excision from face or neck) (H)

(Anaes.)

Fee: $441.60 Benefit: 75% = $331.20

(See para TN.8.23 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: $223.45 Benefit: 75% = $167.60 85% = $189.95

(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: $160.30 Benefit: 75% = $120.25 85% = $136.30

(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), definitive surgical excision of (other than by shave excision) including repair (if performed), 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: $292.35 Benefit: 75% = $219.30 85% = $248.50

(See para TN.8.22, TN.8.23, TN.8.125, TN.8.297 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 of (other than by shave excision) including repair (if performed), 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: $201.10 Benefit: 75% = $150.85 85% = $170.95

(See para TN.8.22, TN.8.23, TN.8.125, TN.8.297 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: $369.50 Benefit: 75% = $277.15 85% = $314.10

(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 of (other than by shave excision) including repair (if performed), 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: $427.05 Benefit: 75% = $320.30 85% = $363.00

(See para TN.8.22, TN.8.23, TN.8.125, TN.8.297 of explanatory notes to this Category)