Education guide - Billing skin lesion treatment and biopsy items under Medicare

Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes on the MBS Online website.

Skin or mucous membrane biopsies for diagnosis - item 30071 and 30072

You can bill MBS item 30071 for a diagnostic biopsy of skin or item 30072 for a diagnostic biopsy of mucous membrane when:

you perform the biopsy as an independent procedure
you send the specimen for pathological examination
the biopsy is clinically necessary to confirm the diagnosis so you can appropriately manage the lesion.

If a shave biopsy results in definitively excising a lesion, you can only bill item 30071 or 30072. If biopsy results show that the patient needs further, clinically relevant treatment, select additional item numbers. Select the item numbers based on the results and treatment method.

If you perform multiple biopsies on separate lesions on the one day, make sure the claim or account notes either:

‘separate sites’
the exact location of the biopsy.

Administrative requirements for skin services

Determining lesion size for MBS item selection

The necessary excision diameter or defect size includes:

the lesion size
a clinically appropriate margin of healthy tissue needed for complete surgical excision.

Make sure you take measurements before excision. You should determine the margin size in line with these National Health and Medical Research Council guidelines:

Clinical practice guide: Basal cell carcinoma, squamous cell carcinoma (and related lesions) - a guide to clinical management in Australia. November 2008. Cancer Council Australia
Clinical practice guidelines for the management of melanoma in Australia and New Zealand. 2008. Ministry of Health, New Zealand.

The image below illustrates the area of the lesion, margin and closure.

Lesion, margin and closure diagram

For items 31356 to 31376 calculate the defect size using:

the average width
the length of the skin lesion
an appropriate margin.

Calculate the necessary excision diameter as follows:

Histology requirements for skin service items

Description	MBS item	Histology requirements
Excision of tumour, cyst, ulcer or scar items	31206 to 31225	If you bill these items, you must send the specimen for histological examination.
Excision of bone or cartilage item	31340
Non-malignant skin lesion items	31357, 31360, 31362, 31364, 31366, 31368 and 31370
Malignant skin lesion items	31356, 31358, 31359, 31361, 31363, 31365, 31367 and 31369	If you bill these items, you must send the specimen for histological examination. You must get histological confirmation of malignancy before you bill these items. If you don’t have confirmation at the time of billing, bill the relevant non-malignant item. You must also send any subsequent specimens for histological examination.
Malignant melanoma items	31371 to 31376
Removal of malignant neoplasm	30196	If you bill these items, you must send the specimen for histological examination. If a specialist dermatologist confirms malignancy before you receive histological results, you can bill this item.
Removal of malignant neoplasm	30202	If you bill these items, you must send the specimen for histological examination or have a specialist dermatologist confirm it as malignant.

Keeping evidence for skin services

You must keep copies of histological reports and any other supporting evidence, such as patient notes and photographs. Photographs should include scale. You can keep electronic records.

Read more about administrative record keeping guidelines for health professionals on the Department of Health (Health) website.

Read the guideline for substantiating proof of malignancy for items 30196 to 30202 on Health’s website.

Billing multiple services

You can usually bill multiple skin service items if you treat more than 1 lesion on the same patient on the same occasion.

Some skin service items are for treating multiple lesions. If you treat a lesion or lesions described in one of these items, the item covers treatment of all lesions of that type.

If you bill for more than 2 procedures on the same occasion, note the exact location of each procedure on the claim or account. For electronic claims, use the appropriate indicator as well as service text.

An episode of care includes both the excision and closure for the same defect. This is true even when excision and closure are at separate attendances.

Read more about billing multiple MBS items.

If you bill multiple items, they may be subject to the multiple operation rule.

Scenario 1 - Billing multiple skin flap items

You have a patient present with a torn earlobe. You perform a flap repair on the front of the earlobe and another flap repair on the rear of the earlobe.

The patient also mentions a lesion on their cheek. The lesion appears to be a small malignant melanoma. You calculate the defect size as 11 mm, excise it and send the specimen for histology.

The next day you receive the histology report and it confirms malignancy. You bill item 45206 x 2 for the 2 skin flaps and 31372 for the excision as it was for a separate defect.

The item description of 45206 says ‘not in association with any of the items 31356 to 31376’.

You can bill all 3 items because the defect being repaired with the local flaps is not the defect created by the excision.

To help us assess the claim, include a note on the account or text noting ‘separate sites’ or the location of each procedure.

Scenario 2 - Billing for multiple lesions

You surgically excise 6 cysts from your patient’s mouth on one occasion. 5 of the cysts are under 10 mm in diameter and the sixth is 14 mm in diameter.

Items 31206 to 31225 are for excising cysts.

Item 31221 is for removing 4-10 lesions that are less than 10 mm in diameter and are on a mucous membrane. You bill 1 item 31221 for the removing all 5 small lesions.

Item 31211 is for removal of 1 lesion that is between 10 mm and 20 mm and is on a mucous membrane. You bill item 31211 for removing the large lesion.

Billing re-excision of malignant lesions

You can bill a malignant excision item twice for the same skin lesion if it requires further excision. You can use malignant skin items for the initial excision of the lesion and, if clinically relevant, the re-excision.

You might need to re-excise a malignant skin lesion:

if the original surgical excision was incomplete
to ensure you remove an adequate margin of healthy tissue around an excised malignant skin lesion to prevent reoccurrence.

If you perform a re-excision, select the relevant item for the excision diameter based on the defect size.

Billing derived fee item 31340

You can bill item 31340 where treatment for a skin malignancy requires the excision of muscle, bone or cartilage and is covered by one of these base items:

31000 to 31005
31356
31358 to 31359
31361
31363
31365
31367
31369
31371 to 31376.

Item 31340 has a 75% derived fee calculation. This means that we’ll calculate the schedule fee at 75% of the schedule fee of the associated base item.

When billing item 31340, list it directly under the base item. If that isn’t possible, note the associated base item.

If you bill two base items with two items 31340, list each 31340 directly under its associated base item. If that isn’t possible, note the base item and site of the procedure for each item 31340.

Skin services covered by attendance items

Treating seborrheic keratosis, by any means, only attracts benefits under attendance items.

Treating fewer than 10 solar keratoses by ablative techniques only attracts benefits under attendance items.

Treating warts and molluscum contagiosum usually only attracts benefits under attendance items, but there are some exceptions. See item descriptions for 30187 and 30189 and MBS explanatory notes for more information.

Lesion treatment methods other than excision

Laser treatments for vascular lesions, items 14100 to 14124

Items 14100 to 14124 are for treating vascular lesions by laser photocoagulation using laser radiation. These items also include any consultation associated with the treatment. If the patient needs a second consultation for a different condition on the same day, you’ll need to note:

that the consultation is for an unrelated issue
the separate times you provided the services.

The items 14100 to 14118 have a maximum number of sessions in a 12-month period. The 12-month period starts on the date of the first session. The maximums are:

14100 - 4 sessions in 12 months
14106, 14115 and 14118 - 6 sessions in 12 months.

If you bill item 14100 or 14124, you need to keep photographic evidence on the patient’s record.

MBS item	Description	Lesion description
14100	For treating vascular abnormalities	On the head or neck and visible from 3 meters
14106	For treating vascular malformations, café-au-lait macules and naevi of Ota	Less than 150 cm2 and visible from 3 meters
14115	For treating vascular malformations, café-au-lait macules and naevi of Ota	More than 150 cm2 and up to 300 cm2
14118	For treating vascular malformations, café-au-lait macules and naevi of Ota	More than 300 cm2
14124	For treating vascular malformations, café-au-lait macules and naevi of Ota	Additional treatment required for a lesion described in 14106 to 14124

Laser treatments for severely disfiguring lesions

Items 30190 and 30191 are for removing severely disfiguring or recurrently bleeding tumours by laser ablation. The items don’t include treating:

melanocytic naevi
sebaceous hyperplasia
dermatosis papulosa nigra
Campbell De Morgan angiomas
seborrheic or viral warts.

These items require that a specialist dermatologist confirms the diagnosis.

MBS item	Description	Number of lesions
30190	Angiofibromas, trichoepitheliomas or other severely disfiguring tumours. Using carbon dioxide laser or erbium laser. Removal from face or neck. Including associated resurfacing.	10 or more
30191	Angiofibromas, trichoepithelioma, epidermal naevi, xanthelasma, pyogenic granuloma, genital angiokeratomas, hereditary haemorrhagic telangiectasia and other severely disfiguring or recurrently bleeding tumours. Carbon dioxide/erbium or other appropriate laser - or curettage and fine point diathermy for pyogenic granuloma only.	1 or more

Other laser skin treatments

The following items are for treatment using either:

carbon dioxide
erbium laser.

Items 45025 and 45026 are for resurfacing of severely disfiguring scarring of the face or neck.

Item 45652 is for treating moderate or severe rhinophyma.

Item 45669 is for a vermilionectomy of cellular abnormalities of the lip that were confirmed through a biopsy.

Treatment for malignant neoplasms

Items 30196 and 30202 are for removing malignant neoplasms from skin or mucous membranes.

These items require that either:

a specialist dermatologist has confirmed the diagnosis
histopathology has proven the diagnosis.

Item 30196 still requires histopathology even if a specialist dermatologist has confirmed the diagnosis. However you don’t need the results before billing.

MBS item	Description
30196	Removal of, by serial curettage, or carbon dioxide laser or erbium laser excision-ablation, including any associated cryotherapy or diathermy
30202	Removal of, by liquid nitrogen cryotherapy using repeat freeze thaw cycles

Injections of glucocorticoid preparations

Items 30207 and 30210 are to treat skin lesions by injecting glucocorticoid preparations.

Item selection for excision of skin lesions

Removal of tumour, cyst, ulcer or scar items 31206 to 31225

These MBS items are for removing a tumour, cyst, ulcer or scar using surgical excision. They don’t include scars removed during the surgical approach at an operation or ones removed using shave excision.

These item numbers require you to send the specimen for histological examination.

Items 31220 and 31225 do not attract benefits for excising viral verrucae - common warts -and seborrheic keratoses.

MBS item	Description	Size of lesion
31206	Removal from a mucous membrane by surgical excision	<10 mm
31211	Removal from a mucous membrane by surgical excision	10 to 20 mm
31216	Removal from a mucous membrane by surgical excision	>20 mm
31220	Removal from cutaneous or subcutaneous tissue - 4 to 10 lesions	<10 mm
31221	Removal from a mucous membrane - 4 to 10 lesions	<10 mm
31225	Removal from cutaneous, subcutaneous tissue or mucous membrane - more than 10 lesions	<10 mm

Excision of non-malignant skin lesions - items 31357, 31360, 31362, 31364, 31366, 31368 and 31370

These MBS items are for excising non-malignant skin lesions such as:

suspicious pigmented lesions
solar keratosis - where clinically indicated
cysts
ulcers
scars other than a scar removed during the surgical approach at an operation.

They are not for viral verrucae - common warts - or seborrheic keratosis.

These item numbers require that you send the specimen for histological examination.

MBS item	Description	Size of lesion
31357	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	<6 mm
31360	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	>6 mm
31362	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	<14 mm
31364	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	>14 mm
31366	Any part of the body other than above	<15 mm
31368	Any part of the body other than above	15 to 30 mm
31370	Any part of the body other than above	>30 mm

Excision of malignant skin lesions - items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369

These MBS items are for excising malignant skin lesions such as:

basal cell carcinomas
squamous cell carcinomas, including keratoacanthoma
cutaneous deposit of lymphoma
cutaneous metastasis from an internal malignancy.

You must get histological malignancy confirmation before billing the relevant skin malignancy item. If histological confirmation of malignancy isn’t ready at the time you issue an account, bill the appropriate non-malignant item.

MBS item	Description	Size of lesion
31356	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	<6 mm
31358	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	>6 mm
31359	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	At least one third of the surface area
31361	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	<14 mm
31363	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	>14 mm
31365	Any part of the body other than above	<15 mm
31367	Any part of the body other than above	15 to 30 mm
31369	Any part of the body other than above	>30 mm

You can bill an incomplete surgical excision of a malignant skin lesion performed with curative intent as a malignant skin lesion excision item even when the patient needs further surgery.

You might need to re-excise:

if the original excision was incomplete
to ensure you remove an adequate margin of healthy tissue to prevent reoccurrence.

If re-excision is necessary, you can bill a second item in this range of items. Base the item you choose on the size of the necessary excision diameter and the item descriptor.

Excision of malignant melanoma - items 31371 to 31376

These MBS items are for excising:

malignant melanoma
appendageal carcinoma
malignant connective tissue tumour of skin
merkel cell carcinoma of skin.

You must get histological malignancy confirmation before billing the relevant item. If histological confirmation of malignancy isn’t ready at the time of issuing an account, bill the appropriate non-malignant item.

MBS item	Description	Size of lesion
31371	Nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area	>6 mm
31372	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	<14 mm
31373	Face, neck, scalp, nipple-areola complex, distal limb - upper and lower	>14 mm
31374	Any part of the body other than above	<15 mm
31375	Any part of the body other than above	15 to 30 mm
31376	Any part of the body other than above	>30 mm

You can bill an incomplete surgical excision of a malignant melanoma performed with curative intent as a malignant melanoma excision item even when the patient needs further surgery.

You might need to re-excise:

if the original excision was incomplete
to ensure you remove an adequate margin of healthy tissue to prevent reoccurrence.

If re-excision is necessary, you can bill a second item in this range of items. Base the item you choose on the size of the necessary excision diameter and the item descriptor.

Item selection for skin flaps

When performing a skin flap procedure with a skin lesion excision, consider the restrictions outlined in the item descriptions.

When you perform multiple excisions or flap items on the same occasion, the claim or account should note the associated excision item, if applicable. If you include 2 or more skin flap items, note the exact location of each one.

MBS item	Association with excision item
45200 45203 45206 45207	Is not payable in association with any item in the skin lesion excision item range 31356 to 31376
45201	Is only payable in association with: Mohs micrographic surgery items 31000 to 31005 malignant skin lesion items 31358, 31359, 31363 or 31369 non-malignant skin lesion items 31360, 31364 or 31370 malignant melanoma items 31371, 31373 or 31376.
45202	Is only payable when the clinical relevance of the procedure is clearly annotated in the patient’s record and either: item 45201 applies and additional flap repair is required for the same defect the excision item billed isn’t associated with 45201, but either: the patient has severe pre-existing scarring, severe skin atrophy or sclerodermoid changes the repair is contiguous with a free margin.

MBS item

Association with excision item

45200
45203
45206
45207

Is not payable in association with any item in the skin lesion excision item range 31356 to 31376

45201

Is only payable in association with:

Mohs micrographic surgery items 31000 to 31005
malignant skin lesion items 31358, 31359, 31363 or 31369
non-malignant skin lesion items 31360, 31364 or 31370
malignant melanoma items 31371, 31373 or 31376.

45202

Is only payable when the clinical relevance of the procedure is clearly annotated in the patient’s record and either:

item 45201 applies and additional flap repair is required for the same defect
the excision item billed isn’t associated with 45201, but either:
- the patient has severe pre-existing scarring, severe skin atrophy or sclerodermoid changes
- the repair is contiguous with a free margin.

Item selection for Mohs surgery

From 1 November 2018, only approved Mohs surgeon specialists can perform Mohs surgery. The surgeon has to be recognised by the Australasian College of Dermatologists.

When you excise more than 1 lesion on the same occasion, you should notate separate sites. This applies to multiple lesions treated by Mohs surgery, as well as lesions treated by other methods.

MBS item	Description	Sections
31000	Head, neck, genitalia, hand, digits, leg - below knee - or foot	6 or less
31001	Head, neck, genitalia, hand, digits, leg - below knee - or foot	7-12
31002	Head, neck, genitalia, hand, digits, leg - below knee - or foot	13 or more
31003	>Any part of the body other than above	6 or less
31004	Any part of the body other than above	7-12
31005	Any part of the body other than above	13 or more

Post-operative treatment - aftercare

The skin service procedures we’ve covered in this guide include:

all professional attendances for a patient’s post-operative treatment until they recover
the final check or examination.

Medicare benefits aren’t payable if the practitioner who performed the procedure provides routine post-operative care.

When the patient can’t return to the treating practitioner for post-operative care, the general practitioner providing the aftercare can bill for it. They should use attendance items.