In Australia, Medicare covers certain types of mole removal if it is considered medically necessary. This typically includes moles that are cancerous or at high risk of becoming cancerous, as well as moles that are causing functional problems or causing significant psychological distress. In general, Medicare does not cover mole removal for cosmetic reasons. If Medicare "covers" mole removal, it does not mean that the entire fee is paid by Medicare.
To determine whether mole removal surgery is covered by Medicare, you will need to consult with a doctor. The doctor will assess the mole and determine whether it meets the criteria for Medicare coverage. If the mole removal is considered medically necessary, you may be eligible for partial or full coverage through Medicare.
Reasons for mole removal being considered medically necessary include:
- The "mole" has signs of being a skin cancer and must be removed to obtain an accurate diagnosis and/or reduce the risk of serious cancer developing. (Note: This does not mean that mole removal can cause cancer.)
- The mole is causing physical/functional problems such as rubbing against clothing, bleeding, persistent discomfort or infection
Medicare covers certain types of mole removal procedures, for example surgical excision or shave excision. It does not cover removal by radiofrequency surgery, cryotherapy, laser, IP or electrocautery.
When we say Medicare "covers" mole removal, we do not mean that it pays for the entire mole removal fee.
Medicare sets a "schedule fee" for the procedure and pays only 85% of this fee, which is usually significantly less than the cost to the practice of providing the mole removal service. This means that any mole removal procedure performed at Spot Check Clinic will result in an out-of-pocket expense.
There is always a risk of getting a scar from mole removal. In some cases, Medicare will cover scar reduction consultations and selected scar removal procedures.
Medicare does not cover any cosmetic mole removal procedure, i.e. where the mole is improved to improve the patient's appearance, or simply because the patients doesn't like the mole.
If you have any questions about whether your mole removal is covered by Medicare, it's a good idea to contact Medicare directly or speak with your doctor for more information.