Does 17315 require prior authorization?

No, 17315 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 17315?

Medicare facility rate: $40.08. Non-facility rate: $79.16. Work RVU: 0.85.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.85

Facility

$40.08

Non-Facility

$79.16

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).
Mohs Micrographic Surgery (MMS) is covered for removal of complex or ill-defined skin cancer when 100% of the surgical margins are histologically examined and the same physician performs both the surgical excision and the histologic evaluation.
MMS is covered when lesion complexity, size, or location make other approaches not medically necessary or reasonable, and documentation explains why alternative simple excision or destruction techniques are inappropriate.
Separate payment is allowed for a nonroutine histochemical stain on frozen tissue during MMS when CPT 88314 is reported with modifier -59.
Both MMS and subsequent formalin-fixed histopathology are covered when tissue distinct from the tissue examined during MMS is submitted for additional pathology and the clinical record clearly documents the reason the submitted tissue is separate (e.g., additional margin or unrelated specimen).

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)

Ask Verity about documentation requirements, denial risks, or coverage in your state.