Download Indications for Mohs Micrographic Surgery

Clinical Policy Title: Indications for Mohs micrographic surgery (MMS)
Clinical Policy Number: 01.03.01
Effective Date:
Initial Review Date:
Most Recent Review Date:
Next Review Date:
March 1, 2014
September 18, 2013
September 16, 2015
September, 2016
Policy contains:
 Indications for Mohs
micrographic surgery (MMS).
 Cost benefits.
Related policies: None
ABOUT THIS POLICY: Select Health of South Carolina has developed clinical policies to assist with making coverage determinations. Select Health of
South Carolina’s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services
(CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional
literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including
any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by Select Health of
South Carolina when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal
laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. Select Health of
South Carolina’s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other
health care providers are solely responsible for the treatment decisions for their patients. Select Health of South Carolina’s clinical policies are
reflective of evidence-based medicine at the time of review. As medical science evolves, Select Health of South Carolina will update its clinical policies
as necessary. Select Health of South Carolina’s clinical policies are not guarantees of payment.
Coverage policy
Select Health of South Carolina considers Mohs micrographic surgery (MMS) to be clinically proven and,
therefore, medically necessary when the following criteria are met:
I. Physician criteria:
 The physician performing the MMS must be highly skilled in the MMS technique and pathology
identification.
 Submitted medical record documentation of the diagnosis must be appropriate for MMS.
 It should be established that MMS is the most appropriate choice for the treatment of the
particular lesion, as described below.
II. Current accepted diagnoses and indications for MMS are:

Basal cell carcinoma (BCC), squamous cell carcinoma, or basalosquamous cell carcinoma that have
one or more of the following features:
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Involves central facial areas, nose, and temple areas of the face (the so-called "mask area" of
the face).
Involve lips, cutaneous and vermillion surfaces, eyelids, eyebrows and periorbital regions, ears
and preauricular and posterior auricular areas.
Aggressive pathology in the following areas:
 Hands and feet.
 Genitalia.
 Nail unit/periungual.
 Large size (2cm or greater).
 Positive margins on recent excision.
 Poorly defined borders.
 In the very young (<40 years of age).
 Radiation-induced.
 In patients with proven difficulty with skin cancers or who are immunocompromised.
 Basal cell nevus syndrome.
 In an old scar (e.g., a Marjolin's ulcer).
 Associated with xeroderma pigmentosum.
 Perineural invasion on biopsy or recent resection.
 Deeply infiltrating lesion or difficulty estimating depth of lesion.
Other skin lesions:
 Angiosarcoma of the skin.
 Keratoacanthoma (recurrent).
 Dermatofibrosarcoma protuberans (DFSP).
 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).
 Adenoid type of squamous cell carcinoma.
 Verrucous carcinoma.
 Atypical fibroxanthoma.
 Leiomyosarcoma or other spindle cell neoplasms of the skin.
 Adenocystic carcinoma of the skin.
 Erythroplasia of Queryrat.
 Apocrine carcinoma of the skin.
 Malignant melanoma (facial, auricular, genital, and digital) when anatomical or technical
difficulties do not allow conventional excision with appropriate margins.
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III. MMS procedure
 If MMS is submitted for one of the skin diagnoses listed under “Other skin lesions” under the
Coverage policy section, the claim must be submitted with diagnosis codes 173.81 – 173.89,
and documentation must be maintained in the medical record that describes that lesion by
name and supports the medical necessity of removal by MMS.
 A biopsy of the skin lesion for which MMS is planned may be necessary for the physician to
determine the exact nature of the lesion(s) to be removed. Occasionally, that biopsy may need
to be done on the same day the MMS is planned. To allow separate payment for a biopsy and
pathology on the same day as MMS, the 59 modifier is appropriate. The 59 modifier is also
appropriate when a separate skin lesion, other than the lesion for which MMS is performed, is
biopsied on the same day that the MMS surgery is performed.
 CPT codes 17311 – 17315 are reserved for the surgeon who removes the lesion, and prepares
and interprets the pathology slides. The surgical pathology codes 88300 – 88309 and 88331 –
88332 and 88342 are part of the MMS, and are bundled into codes 17311 – 17315. The
surgeon should not append modifier 59 to these pathology codes unless they pertain to a
separate biopsy/excision that does not involve MMS. (See section under “Local coverage
determinations” (LCDs.)
III.
Limitations:
All other uses of MMS are not medically necessary:
 MMS is not covered for cosmetic procedures or where lesser procedures (punch biopsies,
excision, or other destructive procedures) are noninferior to MMS surgery.
 Because frozen sections cannot adequately identify melanoma cells at the margin, MMS is not
indicated for treating malignant melanoma. The accepted surgical standard for local control of
a primary melanoma is that it requires wide local excision, with a margin of clinically uninvolved
skin.
Note: If the preparation and interpretation of the slides of tissue taken during the MMS are performed by
someone other than the surgeon or his or her employee, then MMS surgery may not be billed.
Alternative covered services:
Each case must be individualized when considering other treatment options. Depending on the type,
extent, size, and location of nonmelanoma skin cancers (NMSC), other treatment options include:
 Electrodesiccation and curettage.
 Excisional surgery.
 Radiation therapy.
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Topical creams.
Chemotherapy.
Cryosurgery.
Photodynamic therapy.
Laser surgery.
Background
MMS is named after the physician who developed the original technique — Frederic Mohs. Mohs was a
practicing physician in Wisconsin the 1930s who discovered a new way to treat skin cancer tumors.
MMS is a precise tissue-sparing surgical technique to remove and treat selected malignant neoplasms of
the skin. This surgery requires a single surgeon to act in two distinct roles: surgeon and pathologist. The
procedure is done in stages, with successive stages used to remove extensive tumors (as needed).
The majority of simple skin cancers can be managed by excision or destruction techniques. The medical
record should clearly show that MMS was chosen because of the complexity (e.g., poorly defined clinical
borders, possible deep invasion, and prior irradiation), size, or location (e.g., maximum conservation of
tumor-free tissue is important). MMS is usually an outpatient procedure done under local anesthesia (with
or without sedation).
There is increasing evidence to support MMS in the treatment of recurrent and primary BCC and in
squamous cell carcinoma, particularly when there is evidence of perineural invasion. MMS is particularly
effective in the treatment of DFSP, especially in the high-risk head and neck area in which wide, local
excision may not be possible. Developments in freshly excised tissue imaging by confocal fluorescence
microscopy and/or Raman spectroscopy may further refine the technique of MMS. Developments in
immunohistochemistry with rapid staining of frozen sections may make MMS for lentigo maligna and
melanoma in situ more feasible in the future. This is a particular advantage in the management of head and
neck lesions.
The evidence base for MMS for a wide range of cutaneous tumors is growing and the technique continues
to develop. Close collaboration between MMS surgeons, specialist surgical oncologists, and reconstructive
surgeons will provide the highest quality care for patients with some of the most challenging cutaneous
tumors.
Cost-effectiveness of MMS
A number of treatment modalities currently exist for nonmelanoma skin cancer, including microscopically
controlled surgical excision (e.g., MMS traditional surgical excision), radiation therapy, electrodessication
and curettage, cryosurgery, photodynamic therapy, and topical chemotherapeutic agents. MMS has the
significant advantage of the lowest recurrence rates of all treatment modalities, where five-year cure rates
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for MMS for primary BCC are 1 percent relative to surgical excision (10.1 percent), electrodessication and
curettage (7.7 percent), radiation therapy (8.7 percent), and cryotherapy (7.5 percent). Previous studies
have also indicated, across specialties, that dermatologists have the highest rates for complete removal of
nonmelanoma skin cancer— which are significantly greater than those for otolaryngologists (P > 0.02) and
plastic surgeons (P < 0.0008). (See the “Clinical trials” section for conclusion.)
Searches
Select Health of South Carolina searched PubMed and the databases of:
 UK National Health Services Centre for Reviews and Dissemination.
 Agency for Healthcare Research and Quality’s National Guideline Clearinghouse and other evidencebased practice centers.
 The Centers for Medicare & Medicaid Services (CMS).
We conducted searches on September 4, 2015. Search terms were: “basal cell CA, Mohs, and micrographic
(MeSH).”
We included:
 Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater
precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined
transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are
thus rated highest in evidence-grading hierarchies.
 Guidelines based on systematic reviews.
 Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost
studies), reporting both costs and outcomes — sometimes referred to as efficiency studies — which
also rank near the top of evidence hierarchies.
Findings:
Observational studies have consistently demonstrated that MMS has a low recurrence rate, often much
lower than surgical excision, especially for facial nonmelanoma skin cancers. The recurrence rate for MMS
is estimated to be between 1 and 3 percent for primary BCC, and 5 and 7 percent for recurrent BCC. This
compares favorably to reported rates for treatment with surgical excisions, which are estimated at 3 – 10
percent in primary BCC and > 17 percent in recurrent BCC. The only randomized trial performed to date,
which evaluated the rates of recurrence of 397 primary and 201 recurrent facial BCC randomized to MMS
vs. excision, found that after 30 months of follow up, five (3 percent) of the primary BCC recurred after
excision compared with three (2 percent) after MMS. For recurrent tumors, three (3 percent) recurred after
excision compared to none after MMS during 18 months of follow up. After five years of follow up, there
were seven (4.1 percent) recurrences in primary BCC treated with surgical excision compared with four (2.5
percent) in patients treated with MMS — a statistically nonsignificant difference. However, for recurrent
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BCC, only two (2.4 percent) treated with MMS recurred, versus 10 (12. percent) in the excision-treated
patients. This difference significantly favored MMS for recurrent BCC.
MMS is a unique technique that potentially offers the highest cure rates and maximum tissue conservation
in the management of specific primary and recurrent skin cancers. Yet, there are many areas of controversy
that surround MMS, including appropriate indications for its use, technical quandaries (use of curettage,
antibiotic prophylaxis, and management of anticoagulants) and outcomes (recurrence, patient-oriented
outcomes, and cost). This needs assessment summarized recent efforts into these areas in an attempt to
identify research gaps in MMS to help fuel further work. The utility of MMS and its methods for delivery
need more stringent, evidence-based, rigorous study.
Summary of clinical evidence
Citation
Mosterd, et al (2008)
Content, Methods, Recommendations
Key points:
BCC is the most common form of skin cancer and its incidence is still rising worldwide.
Surgery is the most frequently used treatment for BCC, but large randomized controlled trials
with five-year follow up to compare treatment modalities are rare.
 These researchers performed a prospective randomized controlled trial to compare the
effectiveness of surgical excision with MMS for the treatment of primary and recurrent
facial BCC. A total of 408 primary BCC (pBCC) and 204 recurrent BCC (rBCC) in
patients from seven hospitals in the Netherlands were randomly assigned to surgical
excision or MMS.
 The primary outcome was recurrence of carcinoma, diagnosed clinically by visual
inspection with histological confirmation. Secondary outcomes were determinants of
failure and cost-effectiveness.
 Of the 397 BCC subjects who were treated, 113 patients constituting 126 primary BCC
tumors were lost to follow up. Of the 11 recurrences that occurred in patients with
pBCC, seven (4.1%) occurred in patients treated with surgical excision and four (2.5%)
occurred in patients treated with MMS (log-rank test chi [2] 0.718, p = 0.397). Of the 202
rBCC people who were treated, 56 BCC in 52 patients were lost to follow up.
 The difference in the number of recurrences between treatments was not significant for
pBCC, but significantly favored MMS in rBCC.
 The authors concluded that MMS is preferred over surgical excision for treating facial
rBCC, because of significantly fewer recurrences after MMS than after surgical excision.
 However, because there was no significant difference in recurrence of pBCC between
treatment groups, treatment with surgical excision is probably sufficient in most cases of
pBCC.
Marmur and colleagues
(2010)
Key points:
In a single-center study, these researchers evaluated the ability of ultrasound to accurately
determine lesion length and width of tumor borders to reduce the number of surgical stages
(n = 26 MMS patients).
 Ultrasound images were taken to record lesion dimensions, then the investigator
documented clinical estimation of the first stage. Extirpation of the tumor and
histological analysis was then performed.
 A paired-samples t-test revealed no significant difference between clinical and
ultrasound widths (t = -1.324, p = 0.20).
 Similarly, there was no significant difference between the lengths found from clinical
assessment and ultrasound (t = -1.093, p = 0.29).
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Snow, et al (2004)
For different tumor types, there was no significant difference between clinical and
ultrasound widths or lengths for BCC (t = -1.307, p = 0.23; t = -1.389, p = 0.20) or
squamous cell cancer (t = -0.342, p = 0.73; t = 0.427, p = 0.68).
The authors concluded that there is a diagnostic role for high-resolution ultrasound in
MMS, regarding the delineation of surgical margins, but its limitations preclude its
practical adoption presently.
Key points:
This was a retrospective review of a series of 40 consecutive patients with DFSP who
underwent MMS over the preceding 20 years. Of these, there were 29 patients with greater
than five years of follow up who formed the basis of this review.
 There were 16 women and 13 men. Eight patients developed recurrent disease after
previous non-MMS treatment. Site distribution was 45% head and neck, and 55% trunk
and extremities. In the current series, there were no local recurrences, with a local fiveyear cure rate of 100%.
 In the literature review, which included the current series, there were 136 patients with
DFSP who underwent MMS with greater than five years of follow up. Nine patients in
the current series developed local recurrences, including five patients who underwent a
second MMS procedure.
 The local cure rates after the first and second MMS procedures were 93.4% and 98.5%,
respectively. The percentage rate and time to local recurrence was 50% at three years
and 75% at five years. However, 25% of local recurrences appeared late, after the usual
five-year recommendation.
 The authors found that in a series of 29 patients with DFSP and in an accompanying
update of the medical literature, 136 patients with DFSP underwent MMS with greater
than five years of follow up. There were no regional and/or distant metastases.
However, late recurrences beyond the usual recommended five-year follow up may
occur.
 Therefore, all patients with DFSP, especially those with recurrent tumors, should be
followed for an extended period. The accumulated data continues to confirm that, when
DFSP is discovered early and is accessible readily to excision by MMS, a favorable
outcome can be expected with minimal trauma or sacrifice of adjacent normal structures
and with a low recurrence rate.
Glossary
Basal cell carcinoma (BCC) — The most common nonmelanoma skin cancer in the United States, affecting
nearly one million of all Americans.
Current procedural terminology —
Cryostat — A machine that quickly freezes and cuts tissue so that it can be placed on a slide to be
examined.
Dermatofibrosarcoma protuberans (DFSP) — An uncommon skin tumor with high rates of local recurrence.
Clinically, it often masquerades as a benign, indolent tumor on the trunk and extremities. Microscopically, it
extends far beyond assessed clinical margins, spreading locally in the dermis, subcutaneous tissue, and
muscle.
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Microsurgery — Use of a microscope during a surgical procedure to perform a microsurgical technique.
Microsurgical technique — A surgical technique for dissecting tissue under a microscope.
Mohs micrographic surgery (MMS) — A precise tissue-sparing surgical technique to remove selected
malignant neoplasms of the skin. The surgery requires one surgeon to perform two distinct roles: surgeon
and pathologist.
Squamous cell carcinoma (SCC) — An uncontrolled growth of abnormal cells arising in the squamous cells,
which compose most of the skin’s upper layers (the epidermis).References
Professional society guidelines/other:
American Society for Dermatologic Surgery Preceptorship Program Award | American Society for
Dermatologic Surgery.
American Medical Association, CurrentProcedural Terminology: CPT and associated publications.
Blue Cross and Blue Shield General Equivalency Maps and CMS General Equivalency Maps for ICD-9 to ICD10 mapping.
CMS:, CMS Manual System, and other CMS publications and services.
Dawn ME, Dawn AG, Miller SJ. MMS for the treatment of melanoma in situ: a review. Dermatol Surg. 2007;
33(4): 395 – 402.
Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland.
Laser and Skin Surgery Center of Indiana, Carmel, Indiana, USA.
Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Peer-reviewed references:
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal Cell Carcinoma Treated with Mohs Surgery in
Australia II. Outcome at 5-year Follow-Up. J Am Acad Dermatol. 2005;53(3):452 – 457. [PubMed].
Markus J, Assistant Professor of Dermatology and Dermatologic Surgery, Baylor College of Medicine and
MED VA Medical Center Baylor College of Medicine.
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Marmur ES, Berkowitz EZ, Fuchs BS, et al. Use of High-Frequency, High-Resolution Ultrasound Before MOHS
Surgery. Dermatol Surg. 2010; 36(6):841 – 847.
Mosterd K, Krekels GA, Nieman FH, et al. Surgical Excision Versus MOHS Micrographic Surgery for Primary
and Recurrent Basal-Cell Carcinoma of the Face: A Prospective Randomized Controlled Trial with 5-Years'
Follow-Up. Lancet Oncol. 2008; 9(12):1149 – 1156.
Muller FM, Dawe RS, Moseley H, Fleming CJ. Randomized Comparison of MOHS Micrographic Surgery and
Surgical Excision for Small Nodular Basal Cell Carcinoma: Tissue-Sparing Outcome. Dermatol Surg. 2009;
35(9):1349 – 1354.
Otley CC. Mohs' Micrographic Surgery for Basal-Cell Carcinoma of the Face. Lancet. 2005;365(9466):1226 –
1227. Author reply 1227. [PubMed]. Accessed September 3, 2015.
Rowe DE, Carroll RJ, Day CL., Jr. Mohs Surgery is the Treatment of Choice for Recurrent (Previously Treated)
Basal Cell Carcinoma. J Dermatol Surg Oncol. 1989;15(4):424 – 431. [PubMed]. Accessed September 3,
2015.
Rowe DE, Carroll RJ, Day CL., Jr. Long-Term Recurrence Rates in Previously Untreated (Primary) Basal Cell
Carcinoma: Implications for Patient Follow-Up. J Dermatol Surg Oncol. 1989;15(3):315 – 328. [PubMed].
Accessed September 3, 2015.
Sherrif F. Ibrahim, M.D., Ph.D.MD, University of Washington School of Medicine. Seattle, WA.
PhD, Molecular Biotechnology, Institute for Systems Biology at the University of Washington.
BS, Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA.
Smeets Nicole WJ, Krekels Gertruud AM, Ostertag Judith U, et al. Surgical Excision vs Mohs' Micrographic
Surgery for Basal-Cell Carcinoma of the Face: Randomised Controlled Trial. The Lancet. 2004;364:1766 –
1772. [PubMed]. Accessed September 3, 2015.
Snow SN, Gordon EM, Larson PO, et al. Dermatofibrosarcoma Protuberans: A Report on 29 Patients Treated
by MOHS Micrographic Surgery with Long-Term Follow-Up and Review of the Literature. Cancer. 2004;
101(1):28 – 38.
Veronese F, Farinelli P, Zavattaro E, Zuccoli R, Bonvini D, Leigheb G, Colombo E. Basal Cell Carcinoma of the
Head Region: Therapeutical Results of 350 Lesions Treated with Mohs Micrographic Surgery. J Eur Acad
Dermatol Venereol. 2011 Jun 25; [Epub ahead of print] PubMed PMID: 21707774. [PubMed]. Accessed
September 3, 2015.
Clinical trials
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ClinicalTrials.gov Identifier: NCT0088279, Basal Cell Carcinoma Recurrence After Mohs Surgery, first
received: April 16, 2009, last updated: September 14, 2012.
http://www.clinicaltrial.gov/ct2/show/NCT00882791?term=Mohs+micrographic+surgery&rank=10.
Accessed September 4, 2015.
ClinicalTrials.gov Identifier:NCT00571363A Randomized Study Comparing Tissue Conservation in
Conventional Versus Mohs' Surgery of Basal Cell Carcinoma, first received December 11, 2007.
http://www.clinicaltrial.gov/ct2/show/NCT00571363?term=Mohs+micrographic+surgery&rank=7. Accessed
September 4, 2015.
CMS National Coverage Determinations (NCDs):
CMS national coverage policy
Title XVIII of the Social Security Act, Section 1862(a) (1) (A). This section allows coverage and payment for
only those services that are considered to be medically reasonable and necessary.
Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim
that lacks the necessary information to process the claim
Local Coverage Determinations (LCDs):
Louisiana Medicare Services. MOHS Micrographic Surgery. Medicare Part B Local Coverage Determination.
LCD No. AC-02-029. Baton Rouge, LA: Louisiana Medicare; December 15, 2002. Available at:
www.lamedicare.com/provider/medpolb/ac02029.asp. Accessed June 10, 2005.
MMS (L28932). Accessed September 4, 2015.
MMS (L24331).Accessed September 3, 2015.
Commonly submitted codes:
Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not
an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill
accordingly.
CPT Code
Description
Comment
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17311
17312
17313
17314
17315
Mohs micrographic technique, including removal of all gross tumor, surgical
excision of tissue specimens, mapping, color coding of specimens,
microscopic examination of specimens by the surgeon, and histopathologic
preparation including routine stain(s), head, neck, hand, feet, genitalia, or any
location with surgery directly involving muscle, cartilage, bone, tendon, major
nerve or vessels; first stage, up to 5 tissue blocks
Mohs micrographic technique, including removal of all gross tumor, surgical
excision of tissue specimens, mapping, color coding of specimens,
microscopic examination of specimens by the surgeon, and histopathologic
preparation including routine stain(s), head, neck, hand, feet, genitalia, or any
location with surgery directly involving muscle, cartilage, bone, tendon, major
nerve or vessels; each additional stage after first stage, up to 5 tissue blocks
Mohs micrographic technique, including removal of all gross tumor, surgical
excision of tissue specimens, mapping, color coding of specimens,
microscopic examination of specimens by the surgeon, and histopathologic
preparation including routine stain(s) of the trunk, arms or legs; first stage, up
to 5 tissue blocks
Mohs micrographic technique, including removal of all gross tumor, surgical
excision of tissue specimens, mapping, color coding of specimens,
microscopic examination of specimens by the surgeon, and histopathologic
preparation including routine stain(s) of the trunk, arms or legs; each additional
stage after the first stage, up to 5 tissue blocks
Mohs micrographic technique, including removal of all gross tumor, surgical
excision of tissue specimens, mapping, color coding of specimens,
microscopic examination of specimens by the surgeon, and histopathologic
preparation including routine stain(s), each additional block after the first 5
tissue blocks, any stage
These are the only covered ICD-9-CM codes that support medical necessity (LCD ID: B2007.58 R)
ICD-9 Code
140.0
140.1
140.3
140.4
140.5
140.6
140.8
140.9
173.01
173.02
173.09
173.11
173.12
173.19
173.21
173.22
173.29
173.31
173.32
173.39
Description
Comment
Malignant neoplasm of upper lip, vermillion boarder
Malignant neoplasm of lower lip, vermillion boarder
Malignant neoplasm of upper lip, inner aspect
Malignant neoplasm of lower lip, inner aspect
Malignant neoplasm of lip, unspecified, inner aspect
Malignant of commissure of lip
Malignant neoplasm of other sites of lip
Malignant neoplasm of lip, unspecified, vermillion border
Basal cell carcinoma of skin of lip
Squamous cell carcinoma of skin of lip
Other malignant neoplasm of skin of lip
Basal cell carcinoma of eyelid, including canthus
Squamous cell carcinoma of eyelid, including canthus
Other specified malignant neoplasm of eyelid, including canthus
Basal cell carcinoma of skin of ear and external auditory canal
Squamous cell carcinoma of skin of ear and external auditory canal
Other specified malignant neoplasm of skin of ear and external auditory canal
Basal cell carcinoma of skin of other and unspecified parts of face
Squamous cell carcinoma of skin of other and unspecified parts of face
Other specified malignant neoplasm of skin of other and unspecified parts of
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173.41
173.42
173.49
ICD-10 Code
face
Basal cell carcinoma of scalp and skin of neck
Squamous cell carcinoma of scalp and skin of neck
Other specified malignant neoplasm of scalp and skin of neck
Description
Comment
C00.0
C00.1
C00.3
C00.4
C00.5
C00.8
Malignant neoplasm of external upper lip
Malignant neoplasm of external lower lip
Malignant neoplasm of upper lip, inner aspect
Malignant neoplasm of lower lip, inner aspect
Malignant neoplasm of lip, unspecified, inner aspect
Malignant neoplasm of overlapping sites of lip
C00.2
Malignant neoplasm of external lip, unspecified
C00.9
Malignant neoplasm of lip, unspecified
C44.01
C44.02
C44.09
C44.111
C44.112
C44.119
C44.121
C44.122
C44.129
C44.191
C44.192
C44.199
C44.211
C44.212
C44.219
C44.221
C44.222
C44.229
C44.291
C44.292
C44.299
C44.310
C44.311
C44.319
C44.320
C44.321
C44.329
C44.390
Basal cell carcinoma of skin of lip
Squamous cell carcinoma of skin of lip
Other specified malignant neoplasm of skin of lip
Basal cell carcinoma of skin of unspecified eyelid, including canthus
Basal cell carcinoma of skin of right eyelid, including canthus
Basal cell carcinoma of skin of left eyelid, including canthus
Squamous cell carcinoma of skin of unspecified eyelid, including canthus
Squamous cell carcinoma of skin of right eyelid, including canthus
Squamous cell carcinoma of skin of left eyelid, including canthus
Other specified malignant neoplasm of skin of unspecified eyelid, including
canthus
Other specified malignant neoplasm of skin of right eyelid, including canthus
Other specified malignant neoplasm of skin of left eyelid, including canthus
Basal cell carcinoma of skin of unspecified ear and external auricular canal
Basal cell carcinoma of skin of right ear and external auricular canal
Basal cell carcinoma of skin of left ear and external auricular canal
Squamous cell carcinoma of skin of unspecified ear and external auricular
canal
Squamous cell carcinoma of skin of right ear and external auricular canal
Squamous cell carcinoma of skin of left ear and external auricular canal
Other specified malignant neoplasm of skin of unspecified ear and external
auricular canal
Other specified malignant neoplasm of skin of right ear and external auricular
canal
Other specified malignant neoplasm of skin of left ear and external auricular
canal
Basal cell carcinoma of skin of unspecified parts of face
Basal cell carcinoma of skin of nose
Basal cell carcinoma of skin of other parts of face
Squamous cell carcinoma of skin of unspecified parts of face
Squamous cell carcinoma of skin of nose
Squamous cell carcinoma of skin of other parts of face
Other specified malignant neoplasm of skin of unspecified parts of face
12
FC-11192015-P-001 │ Clinical Guideline 01.03.01 Indications for
Mohs micrographic surgery (MMS)
C44.391
C44.399
C44.41
C44.42
C44.49
C44.510
C44.511
C44.519
C44.520
C44.521
C44.529
C44.590
C44.591
C44.599
C44.611
C44.612
C44.619
C44.621
C44.622
C44.629
C44.691
C44.692
C44.699
C44.711
C44.712
C44.719
C44.721
C44.722
C44.729
C44.791
C44.792
C44.799
C44.81
C44.82
C44.89
HCPCS Level
II
Other specified malignant neoplasm of skin of nose
Other specified malignant neoplasm of skin of other parts of face
Basal cell carcinoma of skin of scalp and neck
Squamous cell carcinoma of skin of scalp and neck
Other specified malignant neoplasm of skin of scalp and neck
Basal cell carcinoma of anal skin
Basal cell carcinoma of skin of breast
Basal cell carcinoma of skin of other part of trunk
Squamous cell carcinoma of anal skin
Squamous cell carcinoma of skin of breast
Squamous cell carcinoma of skin of other part of trunk
Other specified malignant neoplasm of anal skin
Other specified malignant neoplasm of skin of breast
Other specified malignant neoplasm of skin of other part of trunk
Basal cell carcinoma of skin of unspecified upper limb, including shoulder
Basal cell carcinoma of skin of right upper limb, including shoulder
Basal cell carcinoma of skin of left upper limb, including shoulder
Squamous cell carcinoma of skin of unspecified upper limb, including shoulder
Squamous cell carcinoma of skin of right upper limb, including shoulder
Squamous cell carcinoma of skin of left upper limb, including shoulder
Other specified malignant neoplasm of skin of unspecified upper limb,
including shoulder
Other specified malignant neoplasm of skin of right upper limb, including
shoulder
Other specified malignant neoplasm of skin of left upper limb, including
shoulder
Basal cell carcinoma of skin of unspecified lower limb, including hip
Basal cell carcinoma of skin of right lower limb, including hip
Basal cell carcinoma of skin of left lower limb, including hip
Squamous cell carcinoma of skin of unspecified lower limb, including hip
Squamous cell carcinoma of skin of right lower limb, including hip
Squamous cell carcinoma of skin of left lower limb, including hip
Other specified malignant neoplasm of skin of unspecified lower limb, including
hip
Other specified malignant neoplasm of skin of right lower limb, including hip
Other specified malignant neoplasm of skin of left lower limb, including hip
Basal cell carcinoma of overlapping sites of skin
Squamous cell carcinoma of overlapping sites of skin
Other specified malignant neoplasm of overlapping sites of skin
Description
Comment
13
FC-11192015-P-001 │ Clinical Guideline 01.03.01 Indications for
Mohs micrographic surgery (MMS)
14
FC-11192015-P-001 │ Clinical Guideline 01.03.01 Indications for
Mohs micrographic surgery (MMS)