Minor surgery skin lesions

Pinnacle practices in Waikato locality can offer and claim for this service where the clinician offering the procedure is appropriately qualified and the procedure is of a type that can be safely carried out in primary care.

All practices at which the service is delivered must meet either:  

• the RNZCGP Foundation standard or
• the RNZCGP Cornerstone accreditation indicators.  

Practices receiving Health Care Home funding can not claim for this service.

The service provides a set fee which can be used to fully or partly reimburse the cost of removal of skin lesions when the patient indicates they cannot afford the full price of this service in primary care.  

The service can only be claimed where the procedure has been delivered by Pinnacle GP members or locums who have the required training and experience, i.e. the GP undertaking procedures must have completed recognised minor surgery training within the past five years.  

All excisions must be sent for histology. 

Patients must:

• be eligible to receive publicly funded health services; and
• be enrolled with a Pinnacle practice; and
• indicate that they cannot afford to pay the full cost of the procedure; and
• have no access to another source of funding such as ACC or private insurance.

Practices can claim for procedures that are of a type that can be safely undertaken by a general medical practitioner (GP) for: 

• clinically suspicious skin cancer
• lesions identified on previous incisional biopsy or punch biopsy to require removal
• a lesion clinically suspicious of being a primary cutaneous carcinoma
• basal cell carcinoma
• squamous cell carcinoma
• naevus or mole with clinically suspicious changes suggestive of melanoma
• a lesion which is recurrently infected or inflamed despite treatment
• a painful lesion such as dermatofibromas, chondrodermatitis helices

To be eligible for funding all procedures must require full thickness skin incision

The service does not include the following procedures:

• complex and difficult procedures that require specialist expertise outside the scope of a general medical practitioner
• recurrence of tumours in high risk areas
• insignificant lesions and non-malignant lesions with only minor cosmetic disfigurement
• diagnostic incisional biopsies and diagnostic punch biopsies 
• the removal of uncomplicated sebaceous cysts
• any follow-up visits associated with the initial procedure. 

Practices receiving the Health Care Home flexible funding package can not claim for this service.

The claim covers the entire procedure. 

All prices are GST inclusive.

Minor surgery skin lesions: $102.22 per procedure    

Claims for General Medical Services (GMS) must not be made for consultations that are part of the service in order to avoid an offset being incurred. 

Please ensure the following is recorded for each procedure claimed under this service; these details are required to complete the claim:

• date of procedure
• NZMC registration reference of GP undertaking the procedure and referring GP if relevant
• NHI of patient
• DOB of patient
• gender of patient
• ethnicity of patient
• provisional diagnosis
• actual diagnosis
• completeness of excision 
• complications (if any) a week after surgery. 

Patients may be charged a co-payment. 
   
For patients referred from other practices the co-payment may include the value of the GMS claim. The co-payment plus the payment under this agreement must not exceed your usual fee for the procedure. 

This service is funded from Pinnacle's flexible funding. 
 
We will actively monitor the number of procedures being performed against the funds available. 

If demand outstrips funds available, we will let you know that the service is suspended. If the service is suspended, we will be unable to fund any claims until further advice is given.