Description

Lesions that cause irritation, pain or bleeding may require removal to alleviate symptoms. Surgical removal is also recommended for any lesion that showspossible signs of malignancy. 

Criteria 

Removal of a benign skin lesion (e.g., 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.

Procedure Codes

Removal of skin tags that do not pose a threat to health or function are considered cosmetic, and therefore considered non-covered. 

Procedure Codes

Diagnosis Codes