Medicare Benefits Schedule - Note TN.8.273

Item 46100 is a modifier item that provides extra funding for burns involving the hands, face and anterior neck.

The modifier item can be co-claimed for the excision of burnt tissue items 46101 to 46111, the immediate closure items 46113 to 46123 and the delayed definitive closure items 46130 to 46135, where excision of burnt tissue or definitive burn wound closure involves greater than 1% of the hands, face or anterior neck.

The modifier item does not apply to whole of face burns items 46112, 46124 or 46136. This is because the fee for items 46112, 46124 and 46136 was set at a level that incorporates the additional complexity of whole of face procedures.

The derived fee for claims including the modifier item will be an additional 40% of the fee for the co-claimed service.

There may be circumstances where a whole of face burns item (46112, 46124 or 46136) can be claimed in the same procedure as a combination of the modifier item (46100) and a co-claimed service covered by clause (b) of item 46100.

For example, a patient may have burns that require excision and immediate definitive closure for the whole of face as well as the anterior neck. The treating surgeon could claim items 46112 and 46124 for the excision and closure of the whole of face. In addition, the surgeon could claim item 46103 for the excision of the anterior neck with the modifier item (46100) and item 46115 for the definitive closure of the anterior neck with the modifier item (46100), because the excision and closure on the anterior neck involves at least 3% but less than 10% of the total body surface area.

Claiming the modifier item

The modifier item (46100) should be claimed immediately after the burns excision or closure item it is associated with.

If multiple burns excision/closure item are eligible to be claimed with the modifier items (i.e. the excision of burnt tissue and definitive burn wound closure involves greater than 1% of the hands, face or anterior neck for multiple items) then the modifier item should be claimed immediately after each of the burns excision/closure items it is associated with. However, where multiple burns excision/closure items are claimed, the modifier item may not necessarily apply to each of the items.

For example, for a claim involving burns excision and closure items 46102, 46114 and 46125, where the modifier item only applies to items 46102 and 46114, the following items should be claimed:

When claiming the modifier item with one of the burns excision or closure items:

• the modifier item and the associated burns excision or closure item is treated as one service for the purpose of the Multiple Operation Rule
• the derived fee resulting from claiming the modifier item is calculated before the Multiple Operation Rule is applied/calculated.

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 46111, 46113 to 46123 and 46125 to 46135 apply;

other than a service to which item 46112, 46124 or 46136 applies

40% of the fee for the co-claimed service

(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: $404.00 Benefit: 75% = $303.00 85% = $343.40

(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: $641.30 Benefit: 75% = $481.00

(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 3% or more but less than 10% of the total body surface (H)

(Anaes.) (Assist.)

Fee: $703.35 Benefit: 75% = $527.55

(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: $1,073.10 Benefit: 75% = $804.85

(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: $1,443.15 Benefit: 75% = $1,082.40

(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: $1,813.90 Benefit: 75% = $1,360.45

(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 40% or more but less than 50% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,184.00 Benefit: 75% = $1,638.00

(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 50% or more but less than 60% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,553.45 Benefit: 75% = $1,915.10

(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: $2,923.60 Benefit: 75% = $2,192.70

(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 70% or more but less than 80% of total body surface, excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,331.00 Benefit: 75% = $2,498.25

(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: $3,730.50 Benefit: 75% = $2,797.90

(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), excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,059.45 Benefit: 75% = $1,544.60

(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, to an area of less than 1% of total body surface, 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) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

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

(H)

(Anaes.) (Assist.)

Fee: $404.00 Benefit: 75% = $303.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, or closure of skin defect secondary to burns contracture release, to an area of at least 1% but less than 3% of total body surface, 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) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

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

(H)

(Anaes.) (Assist.)

Fee: $641.30 Benefit: 75% = $481.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, to an area of at least 3% but less than 10% of total body surface, 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) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface; or

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

(H)

(Anaes.) (Assist.)

Fee: $703.35 Benefit: 75% = $527.55

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure or closure of skin defect secondary to burns contracture release, to an area of at least 10% but less than 20% of total body surface, 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) for a patient aged less than 15 years—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iii) for a patient aged 15 years or over—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is at least 20% of total body surface; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,073.10 Benefit: 75% = $804.85

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 20% but less than 30% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,443.15 Benefit: 75% = $1,082.40

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 30% but less than 40% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,813.90 Benefit: 75% = $1,360.45

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 40% but less than 50% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,184.00 Benefit: 75% = $1,638.00

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 50% but less than 60% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,553.45 Benefit: 75% = $1,915.10

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 60% but less than 70% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,923.60 Benefit: 75% = $2,192.70

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 70% but less than 80% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,331.00 Benefit: 75% = $2,498.25

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Excised burn wound closure, to an area of at least 80% of total body surface, 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,730.50 Benefit: 75% = $2,797.90

(See para TN.8.273, TN.8.274, TN.8.301 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) autologous skin cell suspension for definitive closure; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or
(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,059.45 Benefit: 75% = $1,544.60

(See para TN.8.273, TN.8.274, TN.8.301 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: $404.00 Benefit: 75% = $303.00 85% = $343.40

(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 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: $641.30 Benefit: 75% = $481.00

(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: $888.35 Benefit: 75% = $666.30

(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: $1,628.55 Benefit: 75% = $1,221.45

(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 30% or more of total body surface, and application of skin substitute (skin allograft or biosynthetic epidermal replacements), excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,980.30 Benefit: 75% = $2,235.25

(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, to an area involving less than 1% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $404.00 Benefit: 75% = $303.00

(See para TN.8.273, TN.8.274, TN.8.301 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, to an area involving at least 1% but less than 3% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $641.30 Benefit: 75% = $481.00

(See para TN.8.273, TN.8.274, TN.8.301 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, to an area involving at least 3% but less than 10% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or
(B) for a patient aged 15 years or over—at least 20% of total body surface

(H)

(Anaes.) (Assist.)

Fee: $703.35 Benefit: 75% = $527.55

(See para TN.8.273, TN.8.274, TN.8.301 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, to an area involving at least 10% but less than 20% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) for a patient aged less than 15 years—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting; or
(iii) for a patient aged 15 years or over—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is at least 20% of total body surface;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $1,073.10 Benefit: 75% = $804.85

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 20% but less than 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $2,374.90 Benefit: 75% = $1,781.20

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $3,730.50 Benefit: 75% = $2,797.90

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)

Multiple Operation Rule

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, of whole face, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and
(b) involves:

(i) autologous tissue (split skin graft or other); or
(ii) autologous skin cell suspension; or
(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H)

(Anaes.) (Assist.)

Fee: $2,059.45 Benefit: 75% = $1,544.60

(See para TN.8.273, TN.8.274, TN.8.301 of explanatory notes to this Category)