How do I calculate defect size for MBS skin excision items?

For items 31356–31388, defect size is calculated as: average of the width and length of the skin lesion plus a clinically appropriate margin. Measure before excision. Margin size should follow NHMRC guidelines. The formula is: defect size = ((lesion width + lesion length) / 2) + (2 × margin). The defect size determines which MBS item to use.

When do I use malignant vs benign skin excision item numbers?

If histology confirms malignancy (BCC, SCC, keratoacanthoma, cutaneous lymphoma, cutaneous metastasis), use the malignant items (odd numbers: 31356, 31358, 31361, 31363, etc.). If histology shows the lesion is benign, use the benign items (even numbers: 31357, 31360, 31362, 31364, etc.). Histology confirmation is required before billing malignant items, except for suspected melanoma items 31377–31383.

What MBS item is a punch biopsy?

Punch biopsy is item 30071. Diagnostic biopsy of skin (punch or shave) is item 30071. Specimen must be sent for pathology. Shave biopsy that results in definitive excision — still claim 30071 only. Cryotherapy of malignant lesion (single) is item 30202. Serial curettage of malignant lesion is item 30196. Treatment of fewer than 10 solar keratoses by cryotherapy attracts benefits on an attendance basis only (no separate per-lesion item).

Skin Excision MBS Items

Find the correct MBS item number for skin excisions. Select body location, size, and pathology type.

📋 Source: MBS Online Category 3, Group T8 items. Excision billing rules per MBS explanatory notes. Item numbers and rebates are approximate and subject to change — always verify at mbsonline.gov.au. This is a billing reference tool, not clinical or billing advice. Your clinical judgement and MBS compliance obligations apply.

📌 This is a general guide only — not a billing or clinical directive. MBS item numbers, rules, and fees change. Always verify at mbsonline.gov.au and confirm eligibility with your practice software.

⚠ Always verify against MBS Online before billing. Histology must be sent for all excision items. Defect size = lesion + margins, measured before excision. Reference: DHM Skin Cancer Item Number Guide (PDF).

1. Body location

2. Pathology

Quick reference table — excision items by area

Area	Defect Size	TCUS	BCC/SCC	Melanoma	Suspected Melanoma
Area 1 Nose, eyelid, eyebrow, lip, ear, digit, genitalia	<6 mm	31357	31356	31371	31377
	≥6 mm	31360	31358	31371	31378
Area 2 Face, neck, scalp, nipple-areola, distal limb	<14 mm	31362	31361	31372	31379
Area 2 Face, neck, scalp, nipple-areola, distal limb	≥14 mm	31364	31363	31373	31380
Area 3 Body — everything not Area 1 or 2	<15 mm	31366	31365	31374	31381
	15–30 mm	31368	31367	31375	31382
	>30 mm	31370	31369	31376	31383

TCUS = Tumour, Cyst, Ulcer, Scar. Includes benign lesions — naevi, lipomas, cysts, scars, granulomas.

BCC/SCC items require histology confirmation. If initially excised as TCUS and histology shows malignancy, rebill under the correct BCC/SCC item.

Melanoma items (31371–31376) are for definitive excision of histologically confirmed melanoma, appendageal carcinoma, Merkel cell carcinoma, or malignant connective tissue tumour of skin.

Suspected melanoma items (31377–31383) do not require prior histology — used for diagnostic excision biopsy of clinically suspected melanoma.

Suspected melanoma (histology NOT yet confirmed)

Location	Size	Item
Any location	<14mm	31377
Any location	14–29mm	31378
Any location	≥30mm	31379
Face / scalp / neck / distal limb	<14mm	31380
Face / scalp / neck / distal limb	14–29mm	31381
Face / scalp / neck / distal limb	≥30mm	31382
Nose / eyelid / lip / ear / digit / genitalia	Any	31383

Suspected melanoma items do NOT require histology confirmation before billing. Specimen must still be sent.

Biopsy & destruction items

30071 — Biopsy of skin (punch, incisional)

30072 — Biopsy of skin (mucous membrane)

30071 — Diagnostic skin biopsy (punch/shave) — $62.55

30196 — Serial curettage — malignant (BCC/SCC/IEC) proven on histology

30192 — Premalignant skin lesions, ablative technique (≥10 lesions). For <10 premalignant lesions, bill consultation item only.

30196 — Serial curettage of malignant lesion (proven on histology)

30202 — Cryotherapy of malignant lesion (proven on histology)

Multiple lesion TCUS items

31220 — TCUS 0–10mm, 4–10 lesions

31221 — TCUS 0–10mm, 4–10 lesions (Area 1)

31225 — TCUS 0–10mm, >10 lesions

31206 — TCUS 0–10mm (mucous membrane)

31211 — TCUS 10.1–20mm (mucous membrane)

31216 — TCUS >20mm (mucous membrane)

Flaps & grafts — verified MBS July 2026

⚠️ Co-claiming rule (TN.8.93): Local flap items 45200, 45203, 45206, 45207 cannot be co-claimed with excision items 31356–31383. Item 45201 can be co-claimed with specific items — see billing rules accordion below. Z-plasty = 45201 once per defect. Undermining wound edges is not a flap. Source: MBS Book Mar 2026 TN.8.93

45200 — Local flap, simple & small. Fee $340.30 (85%=$289.30)
❌ Cannot co-claim with 31356–31383

45201 — Muscle, myocutaneous, or skin flap to repair lesion excision. Fee $495.40 (85%=$421.10)
✅ Can co-claim with: 31358, 31360, 31363, 31364, 31369, 31370, 31371, 31373, 31376, 31378, 31380, 31383 — once per defect. Z-plasty = this item.

45202 — Second flap, same defect (additional flap where 45201 applies, or contiguous free margin / severe scarring). Fee $495.40 (85%=$421.10)
Document clinical relevance in records.

45203 — Local flap, complicated or large. Fee $485.95 (85%=$413.10)
❌ Cannot co-claim with 31356–31383. Note: this is a flap item, not wound closure.

45206 — Local flap on eyelid, nose, lip, ear, neck, hand, thumb, finger, or genitalia. Fee $459.15 (85%=$390.30)
❌ Cannot co-claim with 31356–31383

45207 — H-flap or double advancement flap on eyelid, eyebrow, or forehead. Fee $459.15 (85%=$390.30)
❌ Cannot co-claim with 31356–31383

45209 — Pedicled flap (forehead, cross arm, cross leg, abdominal), first stage multistage. Fee $567.05 (75%=$425.30)
🏥 Hospital only. Not a GP clinic item.

45440 — Split skin graft, small defect. 45451 — Full thickness skin graft, defect ≥5mm. Fee $567.05 (85%=$482.00). Each site documented separately. TN.8.266

45665 — Full thickness wedge excision (ear, eyelid, or lip only) | 30219 — I&D abscess/haematoma/furuncle | 31345 — Excision lipoma subcutaneous, 50–149mm

Histology required: All excision items require the specimen to be sent for histological examination. Malignant items (31356–31376) require histology confirmation before billing (except suspected melanoma 31377–31383).

Benign vs malignant: If histology returns benign, use the benign (even-numbered) item. If you billed as malignant and histology returns benign, you must rebill under the correct item.

Multiple lesions: You can bill separately for each excision if at separate sites. Notate "separate sites" or the location of each on the account.

Healing by secondary intention: Items 31356, 31357, 31358, 31360, 31363, 31364, 31369, 31370, 31371, 31373, 31376, and 31377–31383 allow secondary intention healing. The episode includes all wound management attendances.

Flaps and grafts — co-claiming rules (TN.8.93):

45200, 45203, 45206, 45207 — local flap items — cannot be co-claimed with excision items 31356–31383 for the same defect.
45201 (muscle, myocutaneous, or skin flap) — can be co-claimed with items 31358, 31360, 31363, 31364, 31369, 31370, 31371, 31373, 31376, 31378, 31380, 31383.
45451 (full thickness skin graft) — can be claimed for a secondary defect created at the donor site, but not for repair of the primary excision defect if co-claimed with excision items.
Z-plasty = item 45201, claimable once per defect.
The flap repair must be required for adequate wound closure — undermining wound edges before direct suturing is not a flap repair. Direct suture is not a flap.

Consultation + excision: You can bill a consultation item (e.g. 23, 36) with an excision item on the same day if the consultation addresses a clinically separate matter.

BCC: 3–4mm clinical margin for well-defined, nodular BCC. Wider for infiltrative or morphoeic subtypes. Refer to Cancer Council Australia Clinical Practice Guidelines for Keratinocyte Cancer.

SCC: 4–6mm for well-differentiated SCC <20mm. Wider margins for larger, poorly differentiated, or high-risk lesions. Refer to Cancer Council guidelines.

Melanoma in situ: 5mm margin.

Melanoma ≤1mm Breslow: 1cm margin.

Melanoma 1–2mm: 1–2cm margin.

Melanoma 2–4mm: 1–2cm margin.

Melanoma >4mm: 2cm margin.

Always refer to the current NHMRC / Cancer Council clinical practice guidelines. Margins are clinical recommendations, not MBS billing requirements — the MBS determines items by defect size, not margin size.

For MBS items 31361–31364 and 31372–31373, the face is defined as the portion of the head anterior to the hairline and above the jawline.

The nose, eyelid, lip, ear, digit, and genitalia have their own items (31356–31360, 31371) and attract higher rebates due to the complexity of excision in these areas.