Billing and Coding: Removal of Benign Skin Lesions

Medicare covers removal of benign skin lesions when medical necessity is documented — examples include bleeding, pain, itching, inflammation/infection, obstructing lesions, lesions impairing eye function, changes suggesting malignancy, or specified wart conditions (spread, periocular involvement, condyloma, molluscum, association with cervical dysplasia or pregnancy). Cosmetic removals are not covered (use GY modifier and consider an ABN); strict documentation, lesion measurement prior to excision, per-lesion coding, and specified CPT unit rules and modifier usage (25, 24, not 57 for minor procedures) are required for payment.

"Removal of a benign skin lesion is covered when the lesion is symptomatic (bleeding, intense itching, or pain)."

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