Medicare Benefits Schedule - Note TN.8.297

Healing by secondary intention is when a wound is left open to heal, instead of repairing the wound by suture, skin flap or skin graft. 

Items 31356, 31357, 31358, 31360, 31363, 31364, 31369, 31370, 31371, 31373, 31376, 31377, 31378, 31379, 31380, 31381, 31382 and 31383 allow for healing by secondary intention.  

The episode of care includes excision and all attendances for wound management. Therefore, when a wound is left open to heal, only the relevant skin excision item should be claimed. 

Related Items: 31356 31357 31358 31360 31363 31364 31369 31370 31371 31373 31376 31377 31378 31379 31380 31381 31382 31383

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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), definitive surgical excision of (other than by shave excision) including repair (if performed), 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: $258.20 Benefit: 75% = $193.65 85% = $219.50

(See para TN.8.22, 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 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: $127.90 Benefit: 75% = $95.95 85% = $108.75

(See para TN.8.22, TN.8.125, TN.8.297 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 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: $316.00 Benefit: 75% = $237.00 85% = $268.60

(See para TN.8.22, 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 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: $196.00 Benefit: 75% = $147.00 85% = $166.60

(See para TN.8.22, TN.8.125, TN.8.297 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: $284.95 Benefit: 75% = $213.75 85% = $242.25

(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: $196.00 Benefit: 75% = $147.00 85% = $166.60

(See para TN.8.22, TN.8.23, TN.8.125, TN.8.297 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 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: $286.85 Benefit: 75% = $215.15 85% = $243.85

(See para TN.8.22, 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 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: $167.55 Benefit: 75% = $125.70 85% = $142.45

(See para TN.8.22, 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 of (other than by shave excision) including repair (if performed), 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: $416.45 Benefit: 75% = $312.35 85% = $354.00

(See para TN.8.22, 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 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: $416.25 Benefit: 75% = $312.20 85% = $353.85

(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 of (other than by shave excision) including repair (if performed), 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: $410.20 Benefit: 75% = $307.65 85% = $348.70

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

Multiple Operation Rule

Clinically suspected melanoma, surgical excision of (other than by shave excision) including repair (if performed), 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: $127.90 Benefit: 75% = $95.95 85% = $108.75

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

Multiple Operation Rule

Clinically suspected melanoma, surgical excision of (other than by shave excision) including repair (if performed), 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: $196.00 Benefit: 75% = $147.00 85% = $166.60

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

Multiple Operation Rule

Clinically suspected melanoma, 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 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: $156.25 Benefit: 75% = $117.20 85% = $132.85

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

Multiple Operation Rule

Clinically suspected melanoma, 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: $196.00 Benefit: 75% = $147.00 85% = $166.60

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

Multiple Operation Rule

Clinically suspected melanoma, surgical excision of (other than by shave excision) including repair (if performed), 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: $111.40 Benefit: 75% = $83.55 85% = $94.70

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

Multiple Operation Rule

Clinically suspected melanoma, surgical excision of (other than by shave excision) including repair (if performed), 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: $146.50 Benefit: 75% = $109.90 85% = $124.55

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

Multiple Operation Rule

Clinically suspected melanoma, surgical excision of (other than by shave excision) including repair (if performed), 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: $167.55 Benefit: 75% = $125.70 85% = $142.45

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