Does Medicare Cover Mohs Surgery? Coverage, Costs, and What to Expect
Yes. Original Medicare generally covers Mohs surgery when it is medically necessary to treat skin cancer, such as basal cell carcinoma or squamous cell carcinoma. The procedure must be performed by a qualified provider and meet Medicare’s coverage rules. What a patient pays depends on where the surgery takes place, whether the provider accepts Medicare assignment, and whether the patient has supplemental coverage or a Medicare Advantage plan.
What Is Mohs Surgery?
Mohs micrographic surgery is a technique for removing certain skin cancers while preserving as much healthy tissue as possible. The surgeon removes the visible tumor and examines the tissue under a microscope during the procedure. If cancer cells remain at the edges, the surgeon removes another thin layer from the affected area and checks it. The process repeats until the examined margins are clear.
Because the tissue is examined in stages, Mohs surgery can help define the cancer’s extent during treatment. It is commonly considered for cancers in areas where tissue preservation matters, for recurrent or poorly defined tumors, and for cancers with features that make complete removal more challenging. The clinician determines whether it is appropriate; Medicare coverage does not mean the procedure is suitable for every skin cancer.
Does Medicare Cover Mohs Surgery?
Original Medicare covers Mohs surgery when it is reasonable and necessary for a covered medical condition. Medicare Part B generally covers physician services and outpatient care, including medically necessary surgery performed in a doctor’s office or hospital outpatient department. Mohs surgery used to treat a confirmed skin cancer may qualify when documentation supports the diagnosis, treatment plan, and medical necessity.
Coverage is not automatic just because a procedure is called Mohs surgery. Medicare may review the diagnosis, the location and characteristics of the tumor, the treatment history, and the provider’s records. A cosmetic procedure or treatment without a covered medical indication may not be covered. The surgeon’s office can explain the proposed procedure and verify how the claim is expected to be billed.
Which Part of Medicare Pays?
Original Medicare Part B
Part B is usually the main part of Original Medicare that pays for outpatient Mohs surgery. It may cover the surgeon’s professional services and, when applicable, the outpatient facility services associated with the procedure. Separate related services—such as a pathology review, reconstruction, or follow-up care—may be billed separately and assessed under their own coverage and cost-sharing rules.
Before Medicare pays its share, the patient generally must meet the Part B annual deductible. After the deductible, the patient typically owes 20% of the Medicare-approved amount for covered Part B services if the provider accepts assignment. The deductible and other Medicare cost-sharing amounts can change, so patients should check the current figures on Medicare.gov or with Medicare directly.
Medicare Part A
Part A generally does not pay for routine outpatient Mohs surgery. It may become relevant if the patient receives covered care as an inpatient in a hospital, but an inpatient admission must be medically necessary and authorized under Medicare’s inpatient rules. The fact that surgery occurs in a hospital building does not by itself make it Part A care; many hospital procedures are billed as outpatient services under Part B.
Medicare Advantage
Medicare Advantage plans must cover services that Original Medicare covers, but they can use plan networks, referral requirements, and prior authorization for certain services. A plan may also have different copayments or coinsurance from Original Medicare. Patients should contact the plan before scheduling to confirm that the Mohs surgeon and facility are in network, whether authorization is required, and what costs apply.
What Does Mohs Surgery Cost With Medicare?
There is no single price for Mohs surgery. The total depends on the Medicare-approved charges and how the services are billed. Factors can include the number of tissue layers removed and examined, the size and location of the cancer, the setting, reconstruction needs, and whether additional clinicians or facilities submit claims.
For a covered Part B service, a patient with Original Medicare may owe the remaining Part B deductible plus coinsurance, commonly 20% of the Medicare-approved amount after the deductible. The provider’s billed charge is not necessarily the amount Medicare approves. If the provider accepts assignment, the provider agrees to accept the Medicare-approved amount as full payment for the covered service, subject to the patient’s share and any other applicable rules.
If the surgeon does not accept assignment, the patient may face additional costs within Medicare’s limiting-charge rules for many physician services. Patients should ask whether the surgeon accepts assignment and request an estimate before treatment. Estimates can change if the procedure requires additional stages, pathology work, or repair of the surgical site.
| Coverage situation | What may apply |
|---|---|
| Original Medicare, covered outpatient Mohs surgery | Part B deductible and generally 20% coinsurance of the approved amount after the deductible |
| Medicare Supplement (Medigap) | May pay some or all eligible Medicare cost-sharing, depending on the policy and enrollment terms |
| Medicare Advantage | Plan-specific copayments or coinsurance; network and authorization rules may apply |
| Noncovered or cosmetic service | The patient may be responsible for the cost if Medicare denies coverage and required notice rules are followed |
Does Medigap Cover Mohs Surgery Costs?
A Medicare Supplement Insurance policy, also called Medigap, can help pay certain out-of-pocket costs for services covered by Original Medicare. Depending on the policy, it may cover some or all of the Part B coinsurance and possibly other eligible cost-sharing. Medigap does not replace Medicare, and it generally cannot be used with a Medicare Advantage plan.
Coverage varies by plan type and policy terms. Patients should ask their insurer whether the policy pays the applicable Part B cost-sharing and whether any conditions, exclusions, or enrollment restrictions apply. A Medigap policy does not make a service Medicare-covered if Medicare determines that the service is not medically necessary or otherwise excluded.
What Services May Be Billed Separately?
A Mohs appointment can involve several distinct services. The surgeon’s office can explain which services it expects to bill, but the final claim may depend on what is medically necessary and performed. Patients should not assume that every service on the same day is included in one fee.
- Consultation and evaluation: A separate office visit may be billed when the clinician evaluates the cancer or discusses treatment. Medicare may apply cost-sharing to a covered visit.
- Mohs stages and tissue examination: The procedure can involve multiple rounds of tissue removal and microscopic examination. The number of stages depends on the cancer’s margins.
- Wound closure or reconstruction: A repair may be performed by the Mohs surgeon or another clinician. Coverage and cost-sharing depend on the service, medical necessity, and billing arrangement.
- Pathology: The tissue examination integral to Mohs is part of the procedure’s process, but other pathology services may be billed separately depending on what is performed.
- Follow-up care: Postoperative visits and treatment for complications may have separate coverage and cost-sharing rules.
When more than one clinician or practice is involved, patients may receive separate statements. They can compare each bill with the Medicare Summary Notice or their Medicare Advantage explanation of benefits and ask the billing office to clarify unfamiliar charges.
How to Confirm Coverage Before Surgery
Checking coverage in advance can reduce billing surprises. The surgeon’s office can confirm the planned diagnosis and procedure codes and explain whether it expects to bill Medicare or the patient’s plan. However, only Medicare or the Medicare Advantage plan can make a final coverage decision on a claim.
- Ask why Mohs is recommended. Request an explanation of the diagnosis, the reason this technique is appropriate, and whether another treatment is being considered.
- Confirm the setting and billing providers. Find out whether the procedure will be performed in an office or hospital outpatient department and whether another clinician or facility will bill separately.
- Check assignment or network status. With Original Medicare, ask whether the providers accept assignment. With Medicare Advantage, verify network participation and any referral or authorization requirements.
- Request a written cost estimate. Ask what the estimate includes and whether it accounts for additional stages, reconstruction, pathology, and follow-up visits.
- Ask about advance notice of noncoverage. If a provider believes Medicare may not cover a service, ask whether an Advance Beneficiary Notice of Noncoverage (ABN) is appropriate and what the financial consequences would be.
An ABN is generally used by Original Medicare providers to inform a patient that Medicare may deny payment for a particular service. It is not a guarantee that Medicare will deny the claim. Patients should read any notice carefully, ask questions before signing, and keep a copy. Medicare Advantage plans have their own coverage and appeal processes, so plan members should follow the plan’s instructions.
What Can Affect Medicare Coverage?
Coverage can depend on the medical record and the circumstances of treatment. The provider may need to document the skin cancer diagnosis and explain why Mohs surgery is medically appropriate. Relevant clinical details can include tumor location, size, borders, recurrence, prior treatment, and other risk characteristics. The patient should provide accurate medical and insurance information and ask the provider to correct errors in the record.
Medicare’s payment rules and coverage policies can change. Local Medicare Administrative Contractors may publish coverage guidance for services in their regions, and individual claims are evaluated under applicable rules. A provider’s estimate is useful for planning, but it is not a binding guarantee of payment.
What If Medicare Denies the Claim?
If Original Medicare denies payment, the Medicare Summary Notice explains the decision and gives instructions for appealing. Patients should review the stated reason, compare it with the provider’s records, and observe the appeal deadline listed on the notice. The surgeon’s office may be able to provide clinical documentation or help correct a coding or billing error.
Medicare Advantage members should follow the denial notice from their plan, which explains how to request an appeal and the applicable deadlines. If the dispute concerns network status, authorization, or medical necessity, the plan’s member services department can explain the next step. Patients should keep copies of notices, bills, medical records, and communications.
Reliable Sources for Coverage Information
For current plan rules and cost figures, patients can consult Medicare.gov’s coverage information, call Medicare at 1-800-MEDICARE (1-800-633-4227), or contact the Medicare Advantage or Medigap insurer. The surgeon’s billing staff can provide procedure-specific estimates, while Medicare or the plan makes the final coverage determination.
In short, Medicare generally covers medically necessary Mohs surgery for skin cancer under Part B when coverage requirements are met. The patient’s actual cost depends on the deductible, coinsurance, provider billing, other services performed, and whether coverage comes through Original Medicare or a Medicare Advantage plan.