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Mohs Micrographic Surgery (MMS)

Effective Date: January 01, 2019
Revised Date: January 01, 2019
Last Reviewed: January 22, 2020

Description

Mohs Micrographic Surgery (MMS) is a microscopically-controlled tissue-sparing surgical technique of removing complex or ill-defined cancerous tissue of the skin.

Criteria

MMS is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors including, but not limited to, melanoma. MMS may be considered medically necessary for ANY ONE of the following indications:

  • When performed in anatomic areas with high-risk recurrences of cancer; or
  • Recurrent or incomplete excised malignant lesions, regardless of anatomic area; or
  • Tumor occurring in previously irradiated skin areas of any anatomic area; or
  • Cancer displaying *aggressive behavior or rapid growth in any anatomic area; or
  • Cancer with ill-defined borders; or
  • Malignant lesions in immuno-suppressed patients; or
  • Tumors with high-risk metastasis; or
  • Areas of important tissue preservation (ears, face, feet, hands, genitalia, and perianal); or
  • Exceptionally large-sized lesions (2.0 cm or greater) in any anatomic region.

*Aggressive behavior must include ANY ONE of the following histologic characteristics:

  • Sclerotic
  • Morpheaform
  • Fibrosing
  • Metatypical/Infiltrative/Spikey-shaped cell groups
  • Perineural or perivascular involvement
  • Nuclear pleomorphism
  • High-mitotic activity
  • Superficial multicentric

Procedure Codes

17311 17312 17313 17314 17315 88331 88332

Separate payment can be made for a repair, flap, or skin graft following MMS.

Payment may be made for the pre-surgical biopsies of multiple lesions if documentation shows that the biopsies were performed on separate lesions.

Subsequent biopsies of additional tissue blocks should not be reported separately. These additional frozen sections reports with MMS should be combined. Additionally, all other surgical pathology services reported with MMS should be combined and processed under the appropriate Procedure Code.

Diagnosis Codes

C00.0 C00.1 C00.2 C00.3 C00.4 C00.5 C00.6
C00.8 C00.9 C43.0 C43.10 C43.111 C43.112 C43.121
C43.122 C43.20 C43.21 C43.22 C43.30 C43.31 C43.39
C43.4 C43.51 C43.52 C43.59 C43.60 C43.61 C43.62
C43.70 C43.71 C43.72 C43.8 C43.9 C44.00 C44.01
C44.02 C44.09 C44.101 C44.1021 C44.1022 C44.1091 C44.1092
C44.111 C44.1121 C44.1122 C44.1191 C44.1192 C44.121 C44.1221
C44.1222 C44.1291 C44.1292 C44.191 C44.1921 C44.1922 C44.1991
C44.1992 C44.201 C44.202 C44.209 C44.211 C44.212 C44.219
C44.221 C44.222 C44.229 C44.291 C44.292 C44.299 C44.300
C44.301 C44.309 C44.310 C44.311 C44.319 C44.320 C44.321
C44.329 C44.390 C44.391 C44.399 C44.40 C44.41 C44.42
C44.49 C44.500 C44.501 C44.509 C44.510 C44.511 C44.519
C44.520 C44.521 C44.529 C44.590 C44.591 C44.599 C44.601
C44.602 C44.609 C44.611 C44.612 C44.619 C44.621 C44.622
C44.629 C44.691 C44.692 C44.699 C44.701 C44.702 C44.709
C44.711 C44.712 C44.719 C44.721 C44.722 C44.729 C44.791
C44.792 C44.799 C44.80 C44.81 C44.82 C44.89 C44.90
C44.91 C44.92 C44.99 C4A.0 C4A.10 C4A.11 C4A.12
C4A.20 C4A.21 C4A.22 C4A.30 C4A.31 C4A.39 C4A.4
C4A.51 C4A.52 C4A.59 C4A.60 C4A.61 C4A.62 C4A.70
C4A.71 C4A.72 C4A.8 C4A.9 C51.0 C51.1 C51.2
C51.8 C51.9 C52 C57.7 C57.8 C57.9 C60.0
C60.1 C60.2 C60.8 C60.9 C63.00 C63.01 C63.02
C63.10 C63.11 C63.12 C63.2 C63.7 C63.8 C63.9
C76.0 C76.40 C76.41 C76.42 C76.8 C7B.1 D03.0
D03.10 D03.111 D03.112 D03.121 D03.122 D03.20 D03.21
D03.22 D03.30 D03.39 D03.4 D03.51 D03.52 D03.59
D03.60 D03.61 D03.62 D03.70 D03.71 D03.72 D03.8
D03.9 D04.0 D04.10 D04.111 D04.112 D04.121 D04.122
D04.20 D04.21 D04.22 D04.30 D04.39 D04.4 D04.5
D04.60 D04.61 D04.62 D04.70 D04.71 D04.72 D04.8
D04.9 D07.1 D07.2 D07.30 D07.39 D07.4 D07.5
D07.60 D07.61 D07.69 D48.5

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