Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)

Medicare covers removal of specified benign skin lesions only when medical necessity is documented; routine cosmetic removal is non-covered and beneficiary-liable. Medical necessity is met if one or more criteria are documented (bleeding, intense itching, pain, signs of inflammation, obstruction/restricted vision, diagnostic uncertainty with concern for malignancy, prior biopsy showing premalignancy/malignancy, or recurrent trauma), with additional specific wart coverage for periocular conjunctivitis and lesion spread, especially in immunocompromised patients.

"Policy applies to benign skin lesions including seborrheic keratoses, skin tags, milia, molluscum contagiosum, sebaceous (epidermoid) cysts, moles (nevi), acquired hyperkeratosis (keratoderma), and..."

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