Mohs Micrographic Surgery

LCD Information Document Information Source LCD ID N/A LCD ID L34195 Original ICD-9 LCD ID Not Applicable LCD Title Mohs Micrographic Surgery Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 05/07/2026 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description Annual review was performed and no changes were made. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See section 869(f)(1)(A)(i) of the Social Security Act.Title XVIII of the Social Security Act (SSA):Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)This section allows coverage and payment for only those services considered medically reasonable and necessary.Title XVIII of the Social Security Act, Section 1833 (e)This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Publications:CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 30 Physician ServicesCMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 16: 120 Cosmetic SurgeryCMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:40-40.6 Surgeons and Global SurgeryCMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12:60 Payment for Pathology ServicesCMS Transmittal No. 434, Publication 100-04, Medicare Claims Processing Manual, Change Request #3458, January 14, 2005, Addition of CLIA Edits to Certain Health Care Procedure Coding System (HCPCS) Codes for Mohs Surgery. Coverage Indications, Limitations, and/or Medical Necessity Abstract:Mohs micrographic surgery (MMS) is an approach to the excision of skin cancers that aims to achieve the highest possible cure rates and to minimize wound size and consequent distortions at critical sites such as the eyes, ears, nose and lips. Mohs micrographic surgery is a two-step process: the tumor is removed in stages, followed by immediate histologic evaluation of the margins of the specimen(s). Further excision is performed until all margins are clear. The physician performing MMS furnishes both the surgical and pathological services, i.e., the excision and the histologic evaluation of the specimen(s). Indications:Medicare will consider reimbursement for Mohs micrographic surgery for the following indications: Basal cell, squamous cell, or basalosquamous cell carcinomas in anatomic locations where they are prone to recur: Mask area of the face (central face, eyelids, eyebrows, periorbital areas, nose, lips, chin, mandible, periauricular areas, ear, temple, sulci); Forehead, cheeks, and neck; Genitalia; Hands & feet; Scalp. Basal cell carcinomas, squamous cell carcinomas, or basalosquamous carcinomas that have one or more of the following features: Recurrent tumor; Aggressive pathology; Large size (2.0 cm or greater); Positive margins on recent excision; Poorly defined borders; In the very young Radiation-induced; In patients with proven difficulty with skin cancers or who are immunocompromised; In an old scar (e.g., a Marjolin's ulcer); Associated with xeroderma pigmentosum; Deeply infiltrating lesion or difficulty estimating depth of lesion; Perineural invasion on biopsy. Squamous cell carcinoma exhibiting any of the following: Acantholytic histology; Rapid growth; Longstanding duration. Basal cell nevus syndrome Other Skin Lesions: Angiosarcoma of the skin; Keratoacanthoma; Dermatofibrosarcoma protuberans; Malignant fibrous histiocytoma; Sebaceous gland carcinoma; Microcystic adnexal carcinoma; Extramammary Paget's disease; Bowenoid papulosis; Merkel cell carcinoma; Bowen's disease (squamous cell carcinoma in situ); Verrucous carcinoma; Atypical fibroxanthoma; Leiomyosarcoma or other spindle cell neoplasms of the skin; Adenocystic carcinoma of the skin; Erythroplasia of Queryrat; Apocrine or eccrine carcinoma of the skin; Malignant melanoma and lentigo maligna when anatomical or technical difficulties do not allow conventional excision with appropriate margins. Limitations:The physician performing Mohs micrographic surgery must be specifically trained and highly skilled in MMS techniques and pathologic identification.If a surgeon performs an excision using Mohs surgical techniques, but does not personally provide the histologic evaluation of the specimen(s), the CPT codes for MMS included in this LCD may not be used. Standard excision codes should be chosen for such services. Other Comments:Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

Abstract: Mohs micrographic surgery (MMS) is an approach to the excision of skin cancers that aims to achieve the highest possible cure rates and to minimize wound size and consequent distortions at critical sites such as the eyes, ears, nose and lips. Mohs micrographic surgery is a two-step process: the tumor is removed in stages, followed by immediate histologic evaluation of the margins of the specimen(s). Further excision is performed until all margins are clear. The physician performing MMS furnishes both the surgical and pathological services, i.e., the excision and the histologic evaluation of the specimen(s). Indications: Medicare will consider reimbursement for Mohs micrographic surgery for the following indications: Basal cell, squamous cell, or basalosquamous cell carcinomas in anatomic locations where they are prone to recur: Mask area of the face (central face, eyelids, eyebrows, periorbital areas, nose, lips, chin, mandible, periauricular areas, ear, temple, sulci); Forehead, cheeks, and neck; Genitalia; Hands & feet; Scalp. Basal cell carcinomas, squamous cell carcinomas, or basalosquamous carcinomas that have one or more of the following features: Recurrent tumor; Aggressive pathology; Large size (2.0 cm or greater); Positive margins on recent excision; Poorly defined borders; In the very young Radiation-induced; In patients with proven difficulty with skin cancers or who are immunocompromised; In an old scar (e.g., a Marjolin's ulcer); Associated with xeroderma pigmentosum; Deeply infiltrating lesion or difficulty estimating depth of lesion; Perineural invasion on biopsy. Squamous cell carcinoma exhibiting any of the following: Acantholytic histology; Rapid growth; Longstanding duration. Basal cell nevus syndrome Other Skin Lesions: Angiosarcoma of the skin; Keratoacanthoma; Dermatofibrosarcoma protuberans; Malignant fibrous histiocytoma; Sebaceous gland carcinoma; Microcystic adnexal carcinoma; Extramammary Paget's disease; Bowenoid papulosis; Merkel cell carcinoma; Bowen's disease (squamous cell carcinoma in situ); Verrucous carcinoma; Atypical fibroxanthoma; Leiomyosarcoma or other spindle cell neoplasms of the skin; Adenocystic carcinoma of the skin; Erythroplasia of Queryrat; Apocrine or eccrine carcinoma of the skin; Malignant melanoma and lentigo maligna when anatomical or technical difficulties do not allow conventional excision with appropriate margins. Limitations: The physician performing Mohs micrographic surgery must be specifically trained and highly skilled in MMS techniques and pathologic identification. If a surgeon performs an excision using Mohs surgical techniques, but does not personally provide the histologic evaluation of the specimen(s), the CPT codes for MMS included in this LCD may not be used. Standard excision codes should be chosen for such services. Other Comments: Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.