Removal of Benign Skin Lesions

Medicare covers removal of benign skin lesions when clear medical indications are documented—examples include bleeding, pain, itching, inflammation, obstruction, visual restriction, recent enlargement or change, diagnostic uncertainty with concern for malignancy, prior biopsy suggesting malignancy, or recurrent trauma to the lesion site. Wart destruction is covered in specified clinical situations (periocular with conjunctivitis, spread especially in immunosuppressed patients, condyloma/molluscum, or genital warts associated with cervical dysplasia or pregnancy). Cosmetic removal of asymptomatic benign lesions is not covered and the beneficiary is financially liable; documentation, pre-excision measurements, per-lesion reporting, and appropriate modifier use (e.g., 25) are required for billing.

"Removal is covered when the lesion bleeds, itches, or is painful."