Mohs Micrographic Surgery

Mohs micrographic surgery is covered when performed by a qualified MD/DO who provides both excision and histologic evaluation, and when clinical documentation demonstrates complexity, location, size, or histologic features consistent with the 2012 Appropriate Use Criteria. Specific coverage is provided by tumor type (BCC, SCC, melanoma in situ/lentigo maligna, and selected rare malignancies) with explicit size thresholds and Area H/M/L location rules; certain lesions (e.g., actinic keratosis variants, Bowenoid papulosis) and procedures by non-physicians are excluded. Billing must use tissue blocks as the billing unit and rare or atypical cases may require pre-pay review or redetermination.

"Recurrent basal cell carcinoma (any size) or unexpected positive margin on recent excision (healthy, immunocompromised, or genetic syndrome) with aggressive histology is covered for Areas H, M, and L."