Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
This policy describes reimbursement guidelines for reporting Mohs Micrographic Surgery which includes both the excision and pathology services.
All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the CCI Editing Policy and the Laboratory Services Policy.
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Click to Download: Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Questions and Answers
Q: A dermatologist excised a malignant lesion and had the tissue examined by a separate pathologist in the same office complex to ensure clear margins. The pathologist billed separately for their services. May the dermatologist report CPT code 17311 for the surgical service?
A: No. Mohs requires that a single physician act as both surgeon (excision tissue) and pathologist (immediately examining excised tissue to determine clear margins). Per CPT, if either of these responsibilities is delegated to another physician or qualified health care professional who reports the services separately, the surgeon should report the appropriate excision or biopsy code such as CPT codes 11600–11646 or 11102–11107.
Q: A dermatologist performed Mohs surgery on the patient’s cheek and also performed the pathology services. May the dermatologist bill for both services performed, the Mohs surgery and the pathology?
A: No. The pathology examination of the specimen is an inclusive component of the Mohs surgery and should not be reported separately.