Mohs Micrographic Surgery (MMS)

Mohs micrographic surgery is covered when immediate microscopic evaluation of uncertain tumor margins is necessary and when performed by a qualified MD/DO who personally performs both the surgical excision and Mohs histologic interpretation, with documentation supporting medical necessity and adherence to AAD Appropriate Use Criteria. Coverage is specified by tumor type, location (Areas H/M/L), size thresholds, and patient factors (immunocompromised, prior radiation, genetic syndromes), while certain lesions and body-area/size combinations (e.g., many superficial lesions on Area L, actinic keratoses, specified in-situ lesions) are excluded. Billing must follow the companion billing article, with training verification and thorough clinical documentation available for review.

"Mohs micrographic surgery (MMS) is covered when chosen because lesion margins are clinically uncertain and immediate microscopic evaluation of 100% of margins is needed to maximize tissue conservat..."