CurrentUnitedHealthcarePolicy 2025R6008A

Mohs Micrographic Surgery reimbursement and billing rules (CMS 1500)

Governs UnitedHealthcare Community Plan reimbursement and billing rules for reporting Mohs Micrographic Surgery (CPT 17311-17315) on CMS 1500 claims and related pathology/excision coding; applies to providers submitting claims to the plan.

Policy Summary

PayerUnitedHealthcare

PolicyMohs Micrographic Surgery reimbursement and billing rules (CMS 1500)

Policy CodePolicy 2025R6008A

Change TypeAnnual policy year revision

Effective Date

Next Review Date

Key ActionDo not report Mohs CPT codes (17311-17315) when surgical and pathology responsibilities are delegated and pathology is billed separately; instead submit appropriate excision/biopsy codes and documentation.

SourceLink

POLICY UPDATE CHANGES

Annual Policy Year Change reflected in history with updates to reimbursement verbiage and Q&A additions.

17311-17315Mohs procedure codes addressed

88302-88309Example histopathology codes

DeniedSame-date separate pathology

MD/DOProvider requirement

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Mohs Billing and Coverage Criteria

Mohs billing and coverage criteria

Covered when ALL of the following conditions are met:

Mohs CPT codes (17311-17315) are appropriate only when a single physician (MD/DO) performs both the surgical and pathology components and documents use of accepted Mohs technique in the medical record.

ALL of the following

AND: The physician performing Mohs must be an MD or DO (physician-only).
Operative note and pathology documentation must clearly show the Mohs service was performed using accepted Mohs technique, with the physician performing both the surgical and pathology services.

If either the surgical or pathology responsibility is delegated to another physician or qualified health care professional who reports the services separately, Mohs CPT codes (17311-17315) should NOT be reported and will be denied; the surgeon may instead bill the appropriate excision or biopsy code (e.g., 11600-11646 or 11102-11107, example 11641).

Pathology examination of the Mohs specimen is an inclusive component of the Mohs procedure and should not be separately reported by the Mohs surgeon; a separate pathology code submitted by the same provider on the same date will be denied unless documentation shows it was for a distinct biopsy/excision site separate from the Mohs site.

EXCEPTION

If a separate lesion/site is biopsied or excised during the same session and that tissue is sent to an outside pathologist (different provider performing pathology), the surgeon may bill the appropriate excision code for that separate service (e.g., CPT 11641).
In that scenario the outside pathologist may bill appropriate histopathology codes (e.g., CPT 88302-88309, 88331-88332).

Mohs CPT codes reported by non-MD/DO provider specialties will be denied as incorrect coding.

ALL of the following

When wound repair on the same date is performed by a different specialty within the same medical group (shared TIN), multiple procedure payment reduction (MPPR) will NOT be applied to those services.
MPPR still applies when the same provider performs multiple procedures on the same date.

Mohs and Associated Pathology/Excision Codes

Mohs procedure codesCPT

17311	Mohs micrographic technique, first stage
17312	Mohs micrographic technique, second stage (+)
17313	Mohs micrographic technique, subsequent stage
17314	Mohs micrographic technique, add-on
17315	Mohs micrographic technique, add-on

Associated pathology and excision examplesCPT

88302-88309	Surgical pathology codes (examples referenced)
88331-88332	Surgical pathology special stains/micro
11600-11646	Excision codes referenced as alternative to Mohs when pathology delegated
11102-11107	Biopsy codes referenced as alternative
11641	Example excision code for separate lesion

Billing Actions and Payment Rules for Providers

Denial Risk

Billing and denial risk for Mohs and associated pathology

Do not report Mohs CPT codes (17311-17315) when the surgical or pathology responsibilities are delegated and reported separately; in those cases submit the appropriate excision/biopsy code (for example, CPT 11600-11646 or 11102-11107). If a pathology code is submitted by the same provider for the same date of service and records do not indicate it was for a distinct, separate biopsy/excision, the pathology code will be denied as included in the Mohs procedure. When a separate lesion is excised and sent to an outside pathologist, the surgeon may bill the excision code (e.g., CPT 11641) and the pathologist may bill appropriate histopathology codes (e.g., CPT 88302-88309, 88331-88332). Mohs CPT codes reported by non-MD/DO provider specialties will be denied.

Do not report 17311-17315 if pathology is delegated and billed separately; instead bill appropriate excision/biopsy codes (e.g., 11600-11646 or 11102-11107).
Same‑date pathology billed by the same provider without documentation of a separate site will be denied as included in Mohs.
If a separate lesion is sent to an outside pathologist, surgeon may bill excision (e.g., 11641) and the pathologist may bill histopathology (e.g., 88302-88309, 88331-88332).

Key Definitions

Mohs Micrographic Surgery

DefinitionMohs Micrographic Surgery: a precise, tissue-sparing, microscopically controlled surgical technique for selected skin cancers involving staged removal and immediate histologic evaluation of 100% of surgical margins; aims to maximize cure rates and minimize wound size and distortion at critical sites.

Also referred to asMohs or MMS.

Clinical purposeRemoval of complex or ill-defined skin cancer with histologic examination of all surgical margins.

Reimbursement contextThis policy enforces reimbursement requirements for reporting Mohs Micrographic Surgery on CMS 1500 claims (Policy Number 2025R6008A).

NUCC

Full nameNational Uniform Claim Committee (NUCC).

Policy Revision History

2025-04-25annual_policy_year_changeLatest

Annual Policy Year Change; history entries prior to 4/25/2023 archived.

2023-05-01verbiage_and_QA_update

Policy verbiage updated, header branding updated, Table of Contents removed, reimbursement guidelines updated, and Q&A Section added entry #5.

2019-09-01policy_implemented