Learn About Medicare Coverage for Mohs Surgery

What Mohs Surgery Is and Why Medicare Might Cover It

Mohs micrographic surgery is a specialized procedure for removing skin cancer, most commonly basal cell carcinoma and squamous cell carcinoma. Unlike standard skin cancer removal, Mohs surgery removes the cancerous tissue layer by layer, examining each layer under a microscope during the procedure itself. This real-time examination lets the surgeon see exactly where cancer cells end and healthy skin begins, which means they can remove all the cancer while preserving as much healthy skin as possible.

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The procedure gets its name from Dr. Frederic Mohs, who developed the technique in the 1930s. It's particularly useful for skin cancers on the face, ears, hands, and other visible areas where preserving appearance and function matters. Dermatologists or surgeons specially trained in Mohs techniques perform these procedures, often in an outpatient surgical center or office setting.

Medicare Part B typically covers Mohs surgery when a dermatologist or qualified surgeon performs it for diagnosed skin cancer. The procedure code Medicare uses is 17311 or variations depending on the specific work involved. However, coverage hinges on several conditions: the surgery must be medically necessary (meaning recommended by a doctor to treat cancer), the surgeon must be appropriately credentialed, and the patient must have active Medicare Part B coverage.

What makes Mohs surgery stand out in Medicare's view is its efficiency. Because the procedure removes only cancerous tissue during the surgery itself—rather than guessing at margins and potentially removing too much healthy skin or leaving cancer behind—Medicare considers it a legitimate medical treatment. Patients often need fewer follow-up procedures, which can actually reduce overall costs compared to other skin cancer removal methods.

Practical takeaway: If your doctor recommends Mohs surgery for skin cancer, understanding that Medicare Part B generally covers this procedure can help you plan for treatment without worrying about coverage gaps.

How Medicare Part B Coverage Works for Mohs Surgery

Medicare Part B is the portion of Original Medicare that covers outpatient services, including doctor visits, surgical procedures, and diagnostic tests. When you have Part B active and your doctor recommends Mohs surgery for skin cancer, Part B typically pays its share of the procedure's cost.

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Here's how the payment structure works: Medicare establishes a fee schedule that sets what it will pay for specific procedures based on your geographic location. For Mohs surgery, Medicare assigns a specific code (usually 17311, or 17312-17315 for more complex cases) and pays a percentage of the approved amount. Your responsibility depends on whether you've met your Part B deductible for that year and your specific coverage circumstances.

In 2024, the Part B deductible is $240 annually. Once you've paid this deductible, Medicare pays 80% of the approved amount for Mohs surgery, and you're responsible for the remaining 20%. This 80/20 split applies whether you're having the surgery in a hospital outpatient department or a surgical center. The approved amount is not the same as the surgeon's billed amount—it's what Medicare determines is reasonable for that procedure in your area.

The surgeon performing the procedure must be enrolled in Medicare to bill for these services. This enrollment ensures the Medicare fee schedule applies and protects you from unexpected balance billing. If a surgeon isn't Medicare-enrolled, they may bill you differently, and coverage becomes more complicated.

One important distinction: if Mohs surgery happens in a hospital outpatient setting, you may face additional facility charges beyond the surgeon's fee. These facility charges cover the use of the operating room, equipment, and support staff. Both the surgeon's services and facility charges typically fall under Medicare Part B coverage, but they generate separate bills and separate out-of-pocket costs for the patient.

Practical takeaway: Before scheduling Mohs surgery, contact your Medicare provider or the surgeon's office to ask for an estimate of what Medicare will pay. Knowing the approved amount helps you calculate your 20% coinsurance responsibility.

Situations Where Medicare Part B May Not Cover Mohs Surgery

Medicare Part B covers Mohs surgery for medically necessary skin cancer removal, but coverage isn't automatic. Understanding when Medicare might deny or limit coverage helps you avoid surprises. The most common coverage gaps fall into specific categories.

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First, the surgery must treat diagnosed skin cancer. Mohs surgery performed for other skin conditions—such as moles that aren't cancerous, pre-cancerous lesions (like actinic keratosis) that don't have confirmed cancer, or purely cosmetic concerns—may not be covered. Some dermatologists use Mohs technique for pre-cancerous conditions, but Medicare's coverage stance on these is narrower and more case-by-case than for confirmed cancers.

Second, certain Medicare Advantage plans (Part C) operate under different coverage rules than Original Medicare Part B. While many Advantage plans do cover Mohs surgery, the specific coverage details, approved surgeons, and out-of-pocket amounts vary by plan. If you have a Medicare Advantage plan, your plan documents contain the actual coverage details—not what Original Medicare Part B covers.

Third, if your Part B coverage has lapsed or you haven't properly enrolled in Part B, coverage won't apply. Some people with other insurance delay enrolling in Part B and later regret this decision. There are enrollment periods for Part B, and missing them can delay coverage or create gaps.

Fourth, the surgeon must be appropriately credentialed and enrolled with Medicare. If you choose an out-of-network surgeon who doesn't accept Medicare, coverage becomes problematic. These surgeons may bill you directly without regard to Medicare's fee schedule, and you might not get Medicare's negotiated pricing.

Fifth, cosmetic concerns affect coverage decisions. If the skin cancer is small and removed successfully with standard techniques, but the patient wants Mohs specifically for better cosmetic outcomes, Medicare might view the cosmetic component as a patient preference rather than a medical necessity. This distinction matters because it can affect how much Medicare pays.

Practical takeaway: Before scheduling, ask your dermatologist whether they consider your specific situation medically necessary for Mohs surgery and whether they're Medicare-enrolled. This conversation prevents coverage surprises.

Out-of-Pocket Costs You'll Likely Pay

Understanding your potential out-of-pocket costs requires knowing several details about your Medicare coverage and the specific procedure details. These costs can vary significantly based on your circumstances.

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The most straightforward cost is the 20% coinsurance after Medicare pays its 80%. If the approved amount for your Mohs surgery is $1,500, you'd pay $300 (20%) after meeting your deductible. However, approved amounts vary by location and can range anywhere from $800 to $2,500 or more, depending on your geographic area and the complexity of the surgery.

Your annual Part B deductible ($240 in 2024) comes out of your pocket first. If you haven't met it yet, you pay this before the 80/20 split kicks in. Many people meet their deductible early in the year through other medical care, so by the time they have Mohs surgery, the deductible is already satisfied.

Facility charges add another layer if your surgery happens in a hospital outpatient department. These charges are separate from the surgeon's fee and cover facility costs. You'll owe 20% coinsurance on facility charges too, and these can range from $500 to $1,500 depending on the facility and complexity.

Anesthesia, if used, generates another charge. Many Mohs procedures use local anesthesia, which the surgeon administers and bills as part of their service. General anesthesia or monitored sedation, if needed, creates separate anesthesia charges. You'd owe 20% coinsurance on these as well.

Pathology charges for the microscopic examination of tissue samples during the procedure are included in the Medicare-approved Mohs surgery code, so they don't generate separate charges.

If you have a Medigap (supplemental insurance) policy, it may cover some or all of your 20% coinsurance, which would substantially reduce your out-of-pocket costs. If you have a Medicare Advantage plan, your out-of-pocket amounts depend on your specific plan's cost-sharing structure, which might be different from Part B's 20% coinsurance.