How to appeal a Mohs Surgery denial
A Mohs denial usually isn't a rejection of the surgery itself, it's the payer bundling the repair, cutting stages, or denying the same-day biopsy or path, so a $2,000+ case gets paid at a fraction.
Common code: CPT 17311-17315 (Mohs), often with repair 13100-14302 / 15004-15261Why it gets denied
- The closure/repair is bundled into the Mohs code even though it's separately reportable
- Stages beyond the first (17312/17314 add-ons) are denied or capped by units/MUE
- The tumor location or diagnosis doesn't match the payer's Mohs-appropriate-use LCD
- A same-day biopsy or frozen-section path is denied as included when it was distinct
What overturns it
- Report the repair separately with the correct closure code and a distinct-procedure modifier when the closure is a separate, complex service
- Document each stage and map units to the operative note so add-on stages are supported
- Cite the Mohs appropriate-use criteria (AUC) and the LCD confirming the tumor type/site qualifies
- Attach the path and op note showing the biopsy or same-day service was separately identifiable
Worth appealing? Mohs is one of the highest per-case dollar procedures a derm practice bills, so a bundled repair or a dropped stage is real four-figure money, and it's recoverable because the work is fully documented in the op note.
Common questions
How do I appeal a Mohs Surgery denial?
A Mohs denial usually isn't a rejection of the surgery itself, it's the payer bundling the repair, cutting stages, or denying the same-day biopsy or path, so a $2,000+ case gets paid at a fraction. To overturn it: report the repair separately with the correct closure code and a distinct-procedure modifier when the closure is a separate, complex service; document each stage and map units to the operative note so add-on stages are supported; cite the Mohs appropriate-use criteria (AUC) and the LCD confirming the tumor type/site qualifies; attach the path and op note showing the biopsy or same-day service was separately identifiable.
Why do Mohs Surgery claims get denied?
The closure/repair is bundled into the Mohs code even though it's separately reportable; Stages beyond the first (17312/17314 add-ons) are denied or capped by units/MUE; The tumor location or diagnosis doesn't match the payer's Mohs-appropriate-use LCD; A same-day biopsy or frozen-section path is denied as included when it was distinct.
Is a Mohs Surgery denial worth appealing?
Mohs is one of the highest per-case dollar procedures a derm practice bills, so a bundled repair or a dropped stage is real four-figure money, and it's recoverable because the work is fully documented in the op note. You pay 25% only on what's recovered, so there's no cost to working the winnable ones.
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