Does 17311 require prior authorization?

No, 17311 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 17311?

Medicare facility rate: $286.91. Non-facility rate: $667.02. Work RVU: 6.05.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

6.05

Facility

$286.91

Non-Facility

$667.02

A CLIA certification number must be reported on all Mohs claims (item 23 on the CMS-1500 form or electronic equivalent).
The medical record must clearly document and support the circumstances when modifier -59 is used to distinguish a diagnostic biopsy from definitive Mohs surgery.
When appropriate to report modifier -59, report the modifier on the same line as the biopsy procedure codes and do not report -59 on the same line as the Mohs procedure.
Report the appropriate Mohs surgery code with quantities for the specimens mapped in the days/units field (units must reflect number of stages/blocks as applicable).

Bill CPT 17311-17315 for Mohs micrographic surgery when the surgeon removes the lesion and performs the intraoperative pathologic examination (surgeon prepares and interprets slides).
If the specimen(s) from the Mohs procedure are submitted to another physician (pathologist) who performs the frozen or permanent section examination, report the pathology by the performing pathologist (the service is not considered Mohs when the pathologist performs the exam).
Modifier 59 is appropriate to allow separate payment for a skin biopsy and associated pathology on the same day as Mohs Micrographic Surgery (MMS) when the biopsy is performed on a lesion other than the lesion for which MMS is performed.
Modifier 59 is appropriate when the biopsy is of the same lesion as the MMS lesion only if no biopsy of that lesion was performed within the previous 60 days.
Modifier 59 may be appropriate when a recent (within 60 days) biopsy of the same lesion exists but the biopsy results were unobtainable by the Mohs surgeon after reasonable effort.
Laboratory tests associated with MMS may be billed only if the billing facility holds a valid CLIA certificate of registration (type 9), certificate of compliance (type 1), or certificate of accreditation (type 3).

A57477 — Billing and Coding: Mohs Micrographic Surgery

J05

L35494 — Mohs Micrographic Surgery

J05

L33689 — Mohs Micrographic Surgery (MMS)

J09

A57767 — Billing and Coding: Mohs Micrographic Surgery (MMS)

J09

A53883 — Billing and Coding: Mohs Micrographic Surgery (MMS)

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