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Revised Moh’s Surgery Guidelines for UHC

Revised Moh’s Surgery (MMS-  Mohs Micrographic Surgery) Guidelines:

The mentioned below updates are effective from dates of service on and after Sept. 1, 2019.

According to CMS, Mohs surgery should only be performed by a “doctor of medicine (MD) or doctor of osteopathic medicine (DO)” who is specifically trained and highly skilled in Mohs techniques and pathologic identification

In order to maintain the quality of care and services delivered to our members, UnitedHealthcare will only reimburse Mohs surgery to an MD or DO who is specifically trained in both dermatology and pathology

If either the removal of the tumor or the pathology is delegated to another physician or other qualified health care professional, not under the same tax ID number, the Mohs code will be denied.

CMS guidance indicates that pathology examination of the tissue specimen is an inclusive component of Mohs and should not be reported separately.

Accordingly, UnitedHealthcare will deny the pathology examination, if separately reported.

Source: New Guidelines for Mohs Surgery

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