Skin cancer MBS item numbers

Skin or mucous membrane biopsy

• A diagnostic biopsy of skin, as a procedure on its own, with the specimen sent for pathology Item 30071
• A diagnostic biopsy of a mucous membrane, as a procedure on its own Item 30072
• Includes a shave biopsy; used when a biopsy of a lesion is needed to confirm a diagnosis and guide its management TN.8.7

Rules to know

• Taken because a biopsy was needed to confirm the diagnosis and guide management of the lesion TN.8.7
• Done as a procedure on its own, not as part of another procedure on the same area (such as excising that lesion) Item 30071
• A consult on the same day only if clinically relevant and distinct from the biopsy AN.0.9

Skin lesion excision

• Surgically excising a skin lesion (not by shave), including the repair if one is done Item 31357
• The size that picks the version is the necessary excision diameter: the lesion plus a clinically appropriate margin, measured before excising TN.8.125
• Non-malignant lesions, including cysts, ulcers, and scars Item 31357

Rules to know

• A definitive excision of the melanoma or rare skin cancer, including the primary tumour bed (not a first diagnostic excision) Item 31375
• Excised with the intent of removing the whole lesion (with a clinically appropriate margin), not sampling it TN.8.125
• The lesion and margin were measured before excising TN.8.125
• Histology report and supporting evidence kept; photos include a scale TN.8.125
• If the lesion was pre-malignant (such as a solar keratosis): excision was clinically indicated TN.8.22
• Warts and seborrhoeic keratoses cut out are paid as part of the consultation TN.8.22
• A consult on the same day only if clinically relevant and distinct from the excision AN.0.9

Excision of four or more small lesions

• Cutting out 4 to 10 small tumours, lipomas, cysts, ulcers, or scars from the skin or the fat under it at one visit, each surgically excised and sutured, with every specimen sent for histology Item 31220
• Cutting out 4 to 10 small tumours, cysts, ulcers, or scars from a mucous membrane, each site sutured, with every specimen sent for histology Item 31221
• Cutting out more than 10 small lesions, from the skin, the fat under it, or a mucous membrane, each site sutured, with every specimen sent for histology Item 31225

Rules to know

• None of the lesions was a common wart or a seborrhoeic keratosis Item 31225
• A consult on the same day only if clinically relevant and distinct from the excisions AN.0.9

Skin lesion destruction (freezing, curette, cautery, laser)

• Removing warts or molluscum contagiosum by any non-chemical method, in the operating theatre of a hospital Item 30189
• Treating 10 or more premalignant skin lesions, such as solar keratoses, by an ablative technique Item 30192
• Removing 5 or more palmar or plantar warts with a carbon dioxide or erbium laser, in hospital or by a specialist Item 30187

Rules to know

• Seborrhoeic keratoses, however treated, are billed as a consult only TN.8.9
• Fewer than 10 solar keratoses treated by freezing or another ablative method are billed as a consult only TN.8.9
• Warts or molluscum treated without admission to an operating theatre (e.g. frozen in the rooms) are billed as a consult only, apart from TN.8.9's exceptions TN.8.9
• The lesion destroyed was a skin cancer, such as a BCC or SCC (not a keratosis, wart, or other benign lesion) Item 30196
• The lesion destroyed was a pyogenic granuloma, or another severely disfiguring or recurrently bleeding benign tumour (not a keratosis, wart, mole, or skin tag) Item 30191
• A consult on the same day only if clinically relevant and distinct from the treatment AN.0.9

Skin flap repair

• Closing a defect with a flap: skin and the fat under it, raised from the skin beside the defect, left attached by its base (pedicle), and moved into the defect by rotation, advancement, or transposition, or a combination of them TN.8.93
• After a skin lesion is excised, a muscle, myocutaneous, or skin flap to repair that excision, in two versions: with the larger excisions (once per defect); and, with the reason written in the record, an additional flap for the same defect, or a flap after a smaller excision on severely scarred, atrophic, or sclerodermoid skin or next to a free margin Item 45201
• Otherwise (a defect from an injury or another operation), a single stage local flap to repair one defect: simple and small, complicated or large, or on the eyelid, nose, lip, ear, neck, hand, a finger or thumb, or the genitals Item 45206

Rules to know

• A true flap: tissue from beside the defect moved into it, still attached at its base; undermining the edges and stitching them together isn't a flap TN.8.93
• Clinically appropriate: the defect couldn't be closed directly, or the flap was needed to place the scar in the skin creases or landmarks, keep the contour of the face or neck, or avoid distorting nearby structures or openings (such as an eyelid, a nostril, or the lip) TN.8.93
• A consult on the same day only if clinically relevant and distinct from the flap repair AN.0.9

Skin graft (split or full thickness)

• A split thickness skin graft (a thin layer of skin taken from a donor site) to a small defect: under 40 mm across below the knee, beyond the wrist, on the genitals, or on the head or neck, or under 80 mm anywhere else Item 45440
• A split thickness skin graft to a large defect: 40 mm or more on those sites, or 80 mm or more anywhere else Item 45443
• A full thickness skin graft (the whole thickness of skin from a donor site) to one defect with an average diameter of 5 mm or more Item 45451

Rules to know

• The site of each grafted defect is clearly documented TN.8.266
• A consult on the same day only if clinically relevant and distinct from the graft AN.0.9

Common questions

What is the item number for a punch biopsy?

Item 30071: a diagnostic biopsy of skin, as a procedure on its own, with the specimen sent for pathology. A shave biopsy counts too. A punch that removes a small lesion whole also fits an excision, and the purpose decides which: a sample to confirm a diagnosis, or removal with a margin. Item 30071 TN.8.7

Is there an item number for cryotherapy?

For a proven skin cancer, 30202 (liquid nitrogen, with repeat freeze–thaw cycles). For 10 or more solar keratoses, 30192. Fewer than 10 solar keratoses, seborrhoeic keratoses, and warts frozen in the rooms are paid as part of the consultation, with no item of their own. Item 30202 Item 30192 TN.8.9

How is the size of a skin excision measured?

By the necessary excision diameter: the lesion plus a clinically appropriate margin, measured before excising. Keep the histology report, and photos with a scale. TN.8.125

When can I bill a skin cancer excision?

Once histology confirming malignancy has been received: don’t issue the account before then. An excision done for a suspected melanoma can be billed on clinical suspicion. TN.8.22

Can I bill a consult with a skin excision or biopsy?

Only when the consultation is clinically relevant and distinct from the procedure: for example, you assessed the problem and decided on the procedure at this visit, or you managed something else. Not for consent, doing the procedure, or giving its result. AN.0.9

What if I remove four or more small lesions?

Four to 10 small lesions, each 10 mm or less, cut out and sutured at one visit are one item: 31220 from the skin or the fat under it, or 31221 from a mucous membrane. More than 10 is 31225. Every specimen goes to histology. Item 31220 Item 31225 Services Australia guidance

Is closing the excision a separate wound repair?

No. Closing the excision defect is part of the excision, even when it’s closed at a later visit. TN.8.125

What happens to the fees when I do several procedures?

The multiple operation rule applies: the highest fee is paid in full, the next at half, and each other at a quarter. TN.8.2

Sources

• Item 30071: Group T8 Surgical Operations › Subgroup 1 General
• Note TN.8.7: Biopsy for Diagnostic Purposes - (Items 30071 to 30094 and 30820)
• Note TN.8.125: Removal of Skin Lesions - Necessary Excision Diameter - (Items 31356 to 31388)
• Note TN.8.22: Removal of Skin Lesions - (Items 31356 to 31388)
• Item 30196: Group T8 Surgical Operations › Subgroup 1 General
• Item 30202: Group T8 Surgical Operations › Subgroup 1 General
• Item 30192: Group T8 Surgical Operations › Subgroup 1 General
• Note TN.8.9: Treatment of Keratoses, Warts etc (Items 30187, 30189, 30192 and 36815)
• Note AN.0.9: Using time-tiered professional (general) attendance items
• Item 31220: Group T8 Surgical Operations › Subgroup 1 General
• Item 31225: Group T8 Surgical Operations › Subgroup 1 General
• Services Australia guidance: MBS billing for skin lesion treatment and biopsy items: Billing multiple services
• Note TN.8.2: Multiple Operation Rule
• Item 30072: Group T8 Surgical Operations › Subgroup 1 General
• Item 31357: Group T8 Surgical Operations › Subgroup 1 General
• Item 31375: Group T8 Surgical Operations › Subgroup 1 General
• Item 31221: Group T8 Surgical Operations › Subgroup 1 General
• Item 30189: Group T8 Surgical Operations › Subgroup 1 General
• Item 30187: Group T8 Surgical Operations › Subgroup 1 General
• Item 30191: Group T8 Surgical Operations › Subgroup 1 General
• Note TN.8.93: Local Skin Flap - Definition
• Item 45201: Group T8 Surgical Operations › Subgroup 13 Plastic And Reconstructive Surgery
• Item 45206: Group T8 Surgical Operations › Subgroup 13 Plastic And Reconstructive Surgery
• Item 45440: Group T8 Surgical Operations › Subgroup 13 Plastic And Reconstructive Surgery
• Item 45443: Group T8 Surgical Operations › Subgroup 13 Plastic And Reconstructive Surgery
• Item 45451: Group T8 Surgical Operations › Subgroup 13 Plastic And Reconstructive Surgery
• Note TN.8.266: Free Grafting - Split Skin and Full Thickness - (Items 45440, 45443, and 45451)