Summary & Overview
CPT 17311: Mohs Micrographic Surgery for Skin Cancer, Complex Anatomical Sites
CPT code 17311 is a pivotal billing code for Mohs micrographic surgery, a highly specialized procedure used to treat skin cancers in sensitive and complex anatomical areas such as the head, neck, hands, feet, and genitalia. This code encompasses the comprehensive process of tumor removal, specimen mapping, color coding, and microscopic examination by the surgeon, ensuring both thorough cancer excision and tissue preservation. Mohs surgery is widely regarded as the gold standard for skin cancer treatment in these regions due to its high cure rates and minimal impact on surrounding healthy tissue.
Nationally, this code is recognized and reimbursed by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical benchmarks, and recent policy updates relevant to Mohs micrographic surgery. Readers will gain insight into the clinical context of the procedure, typical sites of service, and the importance of accurate coding for reimbursement and compliance. The summary also highlights related codes and modifiers commonly used in conjunction with 17311, offering a comprehensive resource for stakeholders in dermatology and surgical oncology. This article serves as a key reference for understanding the scope and significance of Mohs surgery billing and policy trends across the United States.
CPT Code Overview
CPT code 17311 describes the Mohs micrographic technique, a specialized surgical procedure used in dermatology and surgical oncology for the treatment of skin cancers. This technique involves the removal of all visible tumor tissue, surgical excision of specimens, mapping and color coding of the excised tissue, and microscopic examination by the surgeon. Histopathologic preparation, including routine stains such as hematoxylin and eosin or toluidine blue, is also included. The procedure is specifically performed on the head, neck, hands, feet, genitalia, or any location where surgery directly involves muscle, cartilage, bone, tendon, major nerves, or vessels. Typical sites of service for this procedure are office settings or outpatient hospital facilities, such as Place of Service codes 11, 19, or 22. Mohs surgery is recognized for its precision in removing cancerous tissue while preserving healthy tissue, making it a critical option for complex anatomical areas.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to a dermatology clinic with a biopsy-confirmed malignant neoplasm located on the head, neck, hands, feet, genitalia, or a site where surgery may directly involve muscle, cartilage, bone, tendon, major nerves, or vessels. The patient is scheduled for Mohs micrographic surgery, which includes excision of the tumor, mapping and color coding of tissue specimens, and immediate microscopic examination by the surgeon to ensure complete tumor removal while preserving healthy tissue. The procedure is performed in an office or outpatient hospital setting, such as Place of Service 11, 19, or 22. The clinical workflow includes preoperative assessment, surgical excision, histopathologic evaluation, and possible additional stages if tumor margins are not clear.
Coding Specifications
- Modifier
59: Distinct procedural service—used when a biopsy or pathology is performed on a separate lesion on the same day as Mohs surgery. This modifier distinguishes procedures that are not normally reported together but are appropriate in certain clinical circumstances.
| Modifier Code | Description |
|---|---|
59 | Distinct procedural service—used when a biopsy or pathology is performed on a separate lesion on the same day as Mohs surgery |
Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207ND0900X | Dermatology |
207NS0135X | MOHS-Micrographic Surgery |
207N00000X | Dermatopathology |
- Dermatology (
207ND0900X): Physicians specializing in skin diseases and procedures. - MOHS-Micrographic Surgery (
207NS0135X): Specialists trained in Mohs surgical technique. - Dermatopathology (
207N00000X): Physicians specializing in the microscopic diagnosis of skin diseases.
Related Diagnoses
C00.0: Malignant neoplasm of external upper lip- Relevant for Mohs surgery when the tumor is located on the external upper lip.
C00.1: Malignant neoplasm of external lower lip- Indicates a tumor on the external lower lip, a site appropriate for Mohs surgery.
C00.3: Malignant neoplasm of upper lip, inner aspect- Used when the neoplasm is on the inner aspect of the upper lip.
C00.4: Malignant neoplasm of lower lip, inner aspect- Applies to tumors on the inner aspect of the lower lip.
C00.6: Malignant neoplasm of commissure of lip, unspecified- For neoplasms at the lip commissure, a location suitable for Mohs surgery.
C00.8: Malignant neoplasm of overlapping sites of lip- Used when the tumor involves multiple lip sites.
C43.0: Malignant melanoma of lip- Indicates melanoma on the lip, requiring precise excision.
C43.111: Malignant melanoma of right upper eyelid, including canthus- Relevant for Mohs surgery on the right upper eyelid.
C43.112: Malignant melanoma of right lower eyelid, including canthus- Used for melanoma on the right lower eyelid.
C43.121: Malignant melanoma of left upper eyelid, including canthus- Indicates melanoma on the left upper eyelid.
C43.122: Malignant melanoma of left lower eyelid, including canthus- For melanoma on the left lower eyelid.
C43.21: Malignant melanoma of right ear and external auricular canal- Used for melanoma involving the right ear.
C43.22: Malignant melanoma of left ear and external auricular canal- Indicates melanoma on the left ear.
C43.31: Malignant melanoma of nose- Relevant for Mohs surgery on the nose.
C43.39: Malignant melanoma of other parts of face- Used for melanoma on facial sites not otherwise specified.
C43.4: Malignant melanoma of scalp and neck- Indicates melanoma on the scalp or neck, both sites appropriate for Mohs surgery.
Related CPT Codes
17312: Mohs micrographic surgery, each additional stage after first (use with17311).- Used when additional stages are required beyond the initial excision to achieve clear margins.
17313: Mohs micrographic surgery first stage, trunk, arms, or legs.- Used for Mohs surgery on anatomical sites other than those specified in
17311.
- Used for Mohs surgery on anatomical sites other than those specified in
17314: Mohs micrographic surgery, each additional stage after first for trunk, arms, or legs (use with17313).- Used in conjunction with
17313for additional stages on trunk, arms, or legs.
- Used in conjunction with
17315: Mohs micrographic surgery, each additional tissue block after the first 5 blocks in a stage.- Used when more than five tissue blocks are processed in a single stage.
Clinical Workflow Relation:
17312is commonly used together with17311when multiple stages are needed.17313and17314are alternatives for Mohs surgery on trunk, arms, or legs.17315is used as an add-on code when extensive tissue mapping is required.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 17311 under Medicare is $691.22, while the average commercial rate (BUCA) is $739.23. Commercial payers such as UnitedHealth Group and Cigna report higher mean rates, with UnitedHealth Group at $947.72 and Cigna at $837.68, both significantly above the Medicare benchmark.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the tightest range at $75.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest dispersion at $531.33, reflecting greater variability in commercial payments. Cigna and BUCA also display broad ranges, while Aetna and Blue Cross Blue Shield fall in the middle.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a notably wide range in reimbursement rates for CPT code 17311, with the largest spread observed in Cigna, where the difference between the 75th and 25th percentiles is $878.13. Most commercial payers, including Aetna and UnitedHealth Group, show relatively high mean rates, with Aetna's mean rate far exceeding both the state and national averages. The rate spreads for Aetna and UnitedHealth Group are narrower, indicating more consistent reimbursement levels across providers.
Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates, with Aetna and UnitedHealth Group standing out for their substantial deviations. The table and chart below present the full breakdown of payer-specific rates, highlighting the variability and relative positioning of each payer in Alaska.
Key Insights for Alaska
- Aetna is the highest paying payer in Alaska for CPT 17311, with a mean rate of $2,182.26, while Medicare is the lowest at $668.79.
- All commercial payers in Alaska reimburse at significantly higher rates than their respective national averages, with Aetna and UnitedHealth Group showing the largest deviations.
- The rate spread (difference between 75th and 25th percentiles) is widest for Cigna ($878.13), indicating greater variability in reimbursement compared to other payers.
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