Removal of a benign skin lesion (e.g., skin tags, nevus [mole], sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met:
- There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or
- Inflammation, as evidenced by purulence, oozing, edema, erythema, etc.; or
- The lesion obstructs a body orifice, or restricts vision; or
- There is clinical suspicion of malignancy (e.g., a change in the ABCDEs of skin cancer [asymmetry, border irregularity, color, diameter, evolving or changing in size, shape or color]); or
- Due to its anatomical location, the lesion is prone to being recurrently traumatized; or
- A prior biopsy suggests or is indicative of lesion malignancy.
Removal of a benign skin lesion (e.g., nevus [mole], sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) not meeting above criteria is considered not medically necessary.