Billing and Coding: Mohs Micrographic Surgery (MMS)

Modifier 59 may be used to allow separate payment for biopsy and pathology on the same day as Mohs Micrographic Surgery when the biopsy is on a different skin lesion, when the same-lesion biopsy was not done within the prior 60 days, or when a recent biopsy's results (within 60 days) are unobtainable despite reasonable effort. Laboratory testing associated with MMS must be billed only by facilities holding a valid CLIA certificate type 9, 1, or 3; facilities without a valid certificate or holding only a CLIA waiver (type 2) or PPM certificate (type 4) must not bill for these tests. Physician documentation must clearly state which of the allowed conditions applies for same-day biopsy/pathology billing.

"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 tha..."