What MBS item do I use for cryotherapy of solar/actinic keratoses?

If you are treating 10 or more premalignant (solar/actinic keratosis) lesions by an ablative technique such as cryotherapy in the one attendance, bill item 30192 (Schedule fee $47.30). If you are treating fewer than 10 such lesions, there is no separate procedural item — benefits are payable on the attendance (consultation) item only.

What MBS item is cryotherapy of a malignant skin lesion?

Cryotherapy of a malignant skin lesion (histologically confirmed BCC, SCC, or similar) is item 30202, Schedule fee $57.80. This is a single-lesion item — bill it once per lesion treated.

How long should I freeze an actinic keratosis with liquid nitrogen?

Thin actinic keratoses typically need a short freeze (around 2–3 seconds with a wide spray aperture) followed by a longer thaw (around 20 seconds). Thicker, hyperkeratotic lesions need a longer freeze (around 5–15 seconds) and thaw (40–60 seconds). One freeze-thaw cycle is usually enough; a second cycle may be used for thicker lesions that do not respond to the first. Always judge freeze depth clinically — guidance varies by lesion thickness and individual response.

Cryotherapy MBS Billing & Technique Guide

Which MBS item for cryotherapy, and freeze time/technique by lesion type — actinic keratosis, BCC, and viral warts.

📋 Billing source: MBS Book, July 2026 edition — items 30192 and 30202. Always verify at mbsonline.gov.au before billing.
🧪 Technique source: DermNet NZ — Cryotherapy; Quirk C, "Out cold: cryotherapy for skin lesions", Medicine Today 2018.
This is a general reference, not clinical or billing advice. Your clinical judgement and MBS compliance obligations apply.

1. Which MBS item?

Scenario	Item	Fee	Notes
Malignant lesion (BCC/SCC confirmed on histology), cryotherapy — per lesion	30202	$57.80	Bill once per malignant lesion treated by repeat freeze-thaw cryotherapy.
Premalignant lesions (solar/actinic keratoses), ablative technique (cryotherapy), ≥10 lesions in one attendance	30192	$47.30	One item per attendance, regardless of how many lesions over 10 are treated that visit.
Premalignant lesions (solar/actinic keratoses), cryotherapy, fewer than 10 lesions	No separate item	—	Benefits payable on the attendance (consultation) item only — e.g. 23 or 36. Do not bill 30192 for under 10 lesions.
Viral wart cryotherapy	No separate item	—	Cryotherapy of benign lesions such as viral warts is not separately billable — included in the attendance item.

⚠️ Where this is often confused: there is no MBS item numbered "31255" or "31260" for cryotherapy — those numbers do not appear in the MBS Book for this service. The two cryotherapy-specific items are 30202 (malignant, per lesion) and 30192 (≥10 premalignant lesions, per attendance). Serial curettage of a malignant lesion (a different procedure, sometimes combined with cryotherapy) is item 30196 — see the Skin Excision MBS page for curettage and excision items.

2. Freeze time & technique by lesion type

Lesion	Freeze time	Thaw time	Cycles	Technique notes
Actinic keratosis (AK) — thin	~2–3 sec	~20 sec	1	Use the widest spray aperture. A correctly frozen lesion feels "the consistency of a credit card" on gentle pinch.
Actinic keratosis (AK) — thick/hyperkeratotic	~5–15 sec	~40–60 sec	1, repeat if no response	A second freeze-thaw cycle may be added for thicker lesions. If a lesion persists despite adequate treatment, review the diagnosis — consider biopsy.
Basal cell carcinoma (BCC) — low-risk, well-defined, superficial only	Within general 5–30 sec range	Full thaw before any repeat	Multiple cycles (typically 2)	Reserve for low-risk, well-defined superficial BCC on trunk/limbs — not first-line, and generally avoided on the head and neck. Freeze field should extend ~3–5mm beyond the visible lesion margin. Recurrence rates reported 6–34%, so plan structured follow-up and set expectations with the patient.
Viral wart	~2 sec (small, example only)	Full thaw	Several sessions, spaced weeks apart	Firm application with a cotton applicator or spray. Plantar warts often need more sessions ± adjunctive salicylic acid. Subungual warts generally respond poorly. In children, consider wart paints under occlusion first — cryotherapy can be painful.

Freeze times are general guidance from the cited sources, not a protocol — judge depth clinically, and adjust for site, lesion thickness, and patient factors (e.g. peripheral circulation, anticoagulation, skin type/pigmentation risk).

Immediate redness and swelling at the site, settling over the following day. A blister usually forms within hours — the fluid may be clear or blood-stained, which is expected and not a sign of infection.

A scab forms as the blister dries; this typically lasts about 5–10 days on the face, roughly 3 weeks on the hand, and up to 3 months on the lower leg (slower healing, lower limb circulation). Hypo- or hyperpigmentation at the site is common, especially in darker or olive skin, and usually settles over weeks to months.

A patient-facing handout with this timeline (and what counts as abnormal) is linked below — give it to patients after treatment.

Item 30202 requires the lesion be malignant (histology-confirmed BCC/SCC) — not for clinically suspected but unconfirmed lesions.

Item 30192 is billed once per attendance when ≥10 premalignant lesions are treated by an ablative technique (cryotherapy, curettage, or similar) in that visit — it is not a per-lesion item.

Fewer than 10 premalignant lesions, or cryotherapy of benign lesions (warts, seborrhoeic keratoses), attract benefits on the attendance item only — there is no separate procedural item to bill.

A consultation item can still be billed alongside a procedure item where the consultation addresses a clinically separate matter on the same day.