Which types of skin biopsies are 98020 or 98050?

An in-person interaction with an advanced procedure (98020, 98050) is payable when a physician provides a biopsy of skin or mucosa that is for “medically necessary services generally considered to be accepted standards of care in the medical community currently and not considered experimental in nature.”

Some examples of common skin biopsies that are payable under 98020 or 98050 are:

• Excisional biopsy
• Punch biopsy with sutures
• Punch biopsy without sutures
• Shave biopsy

Skin biopsies are not payable if they are excluded from the LFP Payment Model as per Section 13 [Excluded Services] of the LFP Payment Schedule, such as:

• Services at a facility
• Services to residents of other provinces and territories
• Services to residents of other countries and non-beneficiaries
• Services provided under Health Authority contract
• Services insured by legislation other than the Medicare Protection Act