Does Medicare Cover Mohs Surgery?
The Mohs surgical procedure gets its name from the man who developed it 85 years ago, Frederic Mohs. Today, his procedure is one of the most popular and effective ways for physicians to remove skin cancer from large areas with very little scarring. In fact, studies show that when the Mohs surgical technique is used to remove primary basal-cell carcinoma, the most common type of skin cancer, patients have a 97 to 99.8 percent cure rate.
Mohs procedures can be done in a doctor’s office or medical clinic using local anesthetic. The physician uses a small scalpel to remove one thin layer of skin or tissue at a time. After a layer is removed, it is processed and examined by a pathologist for cancerous cells. If cancer is found, another layer of tissue is removed, and the examination process is repeated. This process continues until there are no more cancerous cells found and the wound can be reconstructed using the Mohs technique, leaving very little scarring.
While Mohs surgery isn’t appropriate for all types of skin cancer, your physician might find that this is a good option for you. If so, your Medicare plan might help you cover a portion of the cost.
How does Medicare cover Mohs surgery?
Medicare covers Mohs surgeries that are medically necessary to treat skin cancer or to prevent a recurrence of skin cancer. Because a Mohs procedure can be done in a physician’s office or an outpatient medical clinic, it is covered by Medicare Part B (medical insurance). However, if you have the procedure done while you are an inpatient in a hospital or skilled nursing facility, Medicare Part A (hospital insurance) may cover the procedure if you are eligible for this benefit.
To be eligible for Medicare coverage of Mohs surgery, your health care provider, who accepts Medicare assignment, must certify that it’s medically necessary. You must also have the procedure done in a medical facility that accepts Medicare.
Medicare Part B pays for 80 percent of the final approved cost of Mohs surgery, and you cover the remaining 20 percent after you’ve paid the Part B deductible for the year. If you have surgery as an inpatient, Medicare Part A covers all costs of the procedure after you pay your Part A deductible for the current benefit period. Part A also charges coinsurance after 60 days of inpatient care.
If you have a Medicare Advantage (Part C) plan, your plan must cover Mohs surgery if your physician certifies that it is medically necessary. Depending on the type of Medicare Advantage plan you have, you might need to use physicians and medical facilities that are in your plan’s set network. Some plans also require referrals from your primary care physician if you need to see a dermatologist or other type of specialist.
If you aren’t certain about your plan’s possible network restrictions, you should ask your provider for details before making any medical appointments.
How much does Mohs surgery cost without Medicare coverage?
It’s difficult to determine the cost of this type of surgery because there are many determining factors involved. However, the estimated national average charge for a Mohs surgical procedure is $3010, and it can range anywhere between $2600 and $12,000 depending on where you have it done, how complex the procedure is, and who does the pathological examinations.