CG-SURG-90 Mohs Micrographic Surgery

This policy addresses Mohs micrographic surgery for skin cancers. It is covered as medically necessary for basal cell carcinoma, squamous cell carcinoma, and melanoma in situ (including lentigo maligna) when lesions meet any of the following: size/location thresholds (≥20 mm on trunk/extremities excluding pretibial, hands, feet, ankles; ≥10 mm on scalp, neck, pretibial; any size on the face, genitalia, hands, or feet) or high-risk features (deep infiltration/uncertain depth, perineural invasion, poorly defined borders, positive margins after recent excision, rapid growth, or recurrence). It is not medically necessary when these criteria are not met.

"Mohs micrographic surgery is consideredmedically necessaryfor the treatment of basal cell carcinoma, squamous cell carcinoma, melanoma in situ (Stage 0; including lentigo maligna), when the followi..."

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