Lesion and Wart Removal
Manitoba only insures lesion and wart removal services under specific circumstances. According to the Health Services Insurance Act:
“Unless the minister is of the opinion that such services are medically required and receives a statement acceptable to the minister showing the reason for the provision of the service, the following services, and all related services, are not insured:
a) cosmetic removal of a benign or asymptomatic nevi, warts, and skin lesions, except for persons 15 years of age and under”
Therefore, the cosmetic removal of a lesion or wart in persons older than 15 is an uninsured service. When lesion or wart removal is “medically necessary,” physicians in Manitoba can select from numerous tariffs. The appropriate tariff to claim will depend on several considerations, including
- the technique used to remove the lesion or wart;
- the number, size or type of lesion(s) or wart(s) removed; and
- the part of the body from which the lesion or wart was removed.
Resection of skin or subcutaneous lesions
- Single lesion — Tariff 0253
- 2nd, 3rd, 4th, 5th lesions (same sitting) — Tariff 0254 for each lesion
- multiple lesions (greater than five lesions) — Tariff 0255 By Report
Lesion or wart removal services not fitting any of the other categories listed below (e.g. asymptomatic cysts or lipomas, scar revision) should generally be claimed under Tariffs 0253, 0254, or 0255.
Plantar wart removal — regardless of the technique used
- One plantar wart — Tariff 0420
- Two plantar warts — Tariff 0421
- Three or more plantar warts — Tariff 0422
Claims may be made for each sitting regardless of whether warts are “new” or “recurrent.”
Cautery Destruction of benign (or pre-malignant) lesions:
- First lesion on the face by any cautery or surgical excision method — Tariff 0400
- Second lesion — Tariff 0432
- Additional lesions — Tariff 0433
- First lesion not located on the face — Tariff 0401
- Second lesion — Tariff 0404
- Additional lesions — Tariff 0405
- Complicated lesions regardless of location — Tariff 0406 By Report
Manitoba Health cannot cap the number of claims under tariff 0405; however, they may request additional information from the physician to verify the medical necessity of removing the lesion.
Cautery destruction of malignant lesions (confirmed by biopsy):
- First lesion on the trunk- Tariff 0407
- Second lesion — Tariff 0434
- Additional lesions — Tariff 0435
- First lesion not located on the trunk — Tariff 0408
- Second lesion — Tariff 0416
- Additional lesions — Tariff 0417
Cryotherapy (excluding plantar warts) Tariff 0403 applies to lesion or wart removal by two specific methods of cryotherapy:
- Nitrogen oxide
- carbon dioxide slush
Consequently, when physicians use one of these two methods to remove a lesion or wart (excluding plantar warts), claim Tariff 0403.
For each patient visit (both initial and follow-up visits for the treatment of lesion or wart), it can be appropriate in some circumstances to claim a visit fee in addition to the claim for wart or lesion removal. However, to claim a visit fee on the same day as a “pre-scheduled” procedure, the examination must be medically necessary.