LCD Reference Article Billing and Coding Article

Billing and Coding: Mohs Micrographic Surgery (MMS)

A57767

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

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General Information

Source Article ID
N/A
Article ID
A57767
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Mohs Micrographic Surgery (MMS)
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
12/11/2023
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33689 Mohs Micrographic Surgery (MMS). Please refer to the LCD for reasonable and necessary requirements.

Mohs Micrographic Surgery (MMS) is the technique for the removal of complex or ill-defined skin cancer with histopathologic examination of 100% of the surgical margins. MMS is a precise tissue-sparing, microscopically-controlled surgical technique used in the removal and treatment of selected malignant neoplasms of the skin. This surgery requires a single surgeon to act in two distinct roles: surgeon and pathologist performing not only the excision but also the histologic evaluation of the specimen(s). It is an approach that aims to achieve the highest possible cure rates and minimize wound size and consequent distortions at critical sites such as the eyes, ears, nose, and lips. MMS is a two-step process in which: (1) the tumor is removed in stages, followed by immediate histologic evaluation of the margins of the specimen(s), and (2) additional excision and evaluation is performed until all margins are clear.

Mohs surgery leaves an open wound, which most often is reconstructed (closed) by the Mohs surgeon. Some wound management is included in the intra and post service work of the Mohs surgery codes, and the Mohs surgeon has the option of repair (closure) codes as appropriate.

At this time, all laboratory tests covered under CLIA are edited at the CLIA certificate level. The MMS procedure codes would require either a CLIA certificate of registration (certificate type code 9), a CLIA certificate of compliance (certificate type code 1), or a CLIA certificate of accreditation (certificate type code 3). A facility without a valid current CLIA certificate will not be permitted to bill for these procedures.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Per the CPT codebook, if repair (closure) is performed, the Mohs surgeon may report separate repair, adjacent tissue transfer or rearrangement, flap, or graft codes. The guidelines at the beginning of applicable sections of the CPT codebook define items that are necessary to report services and procedures. Also, there are other instructions (such as parenthetical notes with selected codes) that may restrict the use of certain additional procedure codes. Physicians must code to specificity and code correctly. The National Correct Coding Initiative edits applicable to certain procedures must not be circumvented.

A biopsy is necessary for the physician to determine the exact nature of the lesion(s) to be removed. Occasionally, that biopsy may need to be done on the same day that the Mohs surgery is performed because there was no prior pathology confirmation of a diagnosis. In order to allow separate payment for a biopsy and pathology on the same day as MMS, the -59 modifier or modifier XU- unusual, non-overlapping service is appropriate when there is no biopsy of the lesion for which Mohs surgery is performed within 60 days of the Mohs surgery or when the biopsy is performed on a lesion that is not associated with the Mohs surgery.

If a pathology procedure is performed on the same day as the Mohs surgical procedure, documentation must support a separate excision/biopsy/repair was performed. Report diagnostic skin biopsy (11102 - 11107) and frozen section pathology (88331) with modifier -59 or modifier XS-separate structure to distinguish from the subsequent definitive surgical procedure of Mohs surgery.

If additional special pathology procedures, stains, or immunostains are required, use 88311-88314, 88341, 88342, and 88344.

Do not report 88314 in conjunction with 17311-17315 for routine frozen section stain (e.g., hematoxylin and eosin, toluidine blue) performed during Mohs surgery. When a non-routine histochemical stain on frozen tissue is utilized, report 88314 with modifier 59 or modifier XU-unusual, non-overlapping service.

Do not report 88302-88309 on the same specimen as part of the Mohs surgery.

Diagnosis(es) must be present on any claim submitted and must be coded to the highest level of specificity.

If repair is performed, use separate repair, flap, or graft codes. The repair of wounds may be classified as simple, intermediate, or complex.

Simple repair is used when the wound is superficial, e.g., involving primarily epidermis or dermis or subcutaneous tissue without significant involvement of deeper structures and requires a simple one layer closure.

Intermediate repair includes the repair of wounds that, in addition to the above, required layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal closure).

Complex repair includes the repair of wounds requiring more than layered closure, such as scar revision, debridement, extensive, undermining, stents or retention sutures.

Adjacent tissue transfer or rearrangement codes are used for excision (including lesion) and/or repair of adjacent tissue transfer or rearrangement (e.g., Z-plasty, W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap). Undermining alone of adjacent tissues to achieve closure, without additional incisions, does not constitute adjacent tissue transfer.

Skin graft necessary to close secondary defect is considered an additional procedure. For purposes of code selection, the term “defect” includes the primary and secondary defects. The primary defect resulting from the excision and the secondary defect resulting from flap design to perform the reconstruction are measured together to determine the code.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The physician must document in the patient’s medical record that the diagnosis is appropriate for MMS and that MMS is an appropriate choice as the treatment of the particular lesion. Also, the options for care (both the primary procedure options and repair options) must be discussed with the patient and clearly noted in the pre-procedure (or post procedure as appropriate) documentation. In summary, the minimal medical need documentation entails that the beneficiary was informed of their treatment options and explained the risks/benefits of the MMS technique and associated repair.
  5. Operative notes and pathology documentation in the patient’s medical record should clearly show that MMS was performed using accepted MMS technique, in which the physician acts in two integrated and distinct capacities: surgeon and pathologist (therefore confirming that the procedure meets the definition of the CPT code[s]).
  6. Operative documentation should note: location, number, and size of the lesion(s); number of stages performed; number of specimens per stage. Histology documentation must include the following: (a) First stage: depth of invasion; pathological pattern of the tumor; cell morphology; if present, note perineural invasion of scar tissue. (b) Subsequent stages: if the tumor characteristics are the same as in the first stage, note this fact only. If the tumor characteristics are different from the first stage, describe the differences.
  7. Measurement of the primary lesion necessitating MMS and measurements in support of repair or related procedures (such as but not limited to adjacent tissue transfer/rearrangements, grafts/flaps) completing the MMS procedure and confirming the primary defect measurement or other relevant measurements should be verifiable. Documentation of the clinical tumor border definition may be accomplished by preoperative photography with the skin stretched to delineate the visible clinical borders with or without debulking curettage (using a centimeter ruler or relation of size by another anatomic structure). Postoperative photography to document the defect may also be considered, especially for small lesions that have a significant subepithelial component (i.e., tip of the iceberg phenomenon). It is understood that photographic documentation may not be possible in a small percentage of cases because of technical difficulties.
  8. When the surgical defect created by MMS requires reconstruction, it should be clear on the documentation that the reconstructive technique performed was an appropriate choice to preserve functional capabilities and to restore physical appearance.
  9. If one of the NCCI associated modifiers (XE-separate encounter, XP-separate practitioner, XS-separate structure, XU-unusual, non-overlapping service) is used with a skin biopsy/pathology code on the same day the MMS was performed, physician documentation must clearly support the use of the modifier(s).
  10. If a pathology code is billed on the same day as MMS, documentation must support a separate excision/biopsy/repair was performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(5 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
59 DISTINCT PROCEDURAL SERVICE: UNDER CERTAIN CIRCUMSTANCES, THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS DISTINCT OR INDEPENDENT FROM OTHER SERVICES PERFORMED ON THE SAME DAY. MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES. THIS MAY REPRESENT A DIFFERENT SESSION OR PATIENT ENCOUNTER, DIFFERENT PROCEDURE OR SURGERY, DIFFERNET SITE OR ORGAN SYSTEM, SEPARATE INCISION/EXCISION, SEPARATE LESION, OR SEPARATE INJURY (OR AREA OF INJURY IN EXTENSIVE INJURIES) NOT ORDINARILY ENCOUNTERED OR PERFORMED ON THE SAME DAY BY THE SAME PHYSICIAN. HOWEVER, WHAN ANOTHER ALREADY ESTABLISHED MODIFIER IS APPROPRIATE IT SHOULD BE USED RATHER THAN MODIFIER -59. ONLY IF NO MORE DESCRIPTIVE MODIFIER IS AVAILABLE, AND THE USE OF MODIFIER -59 BEST EXPLAINS THE CIRCUMSTANCES, SHOULD MODIFIER -59 BE USED. MODIFIER CODE 09959 MAY BE USED AS AN ALTERNATE TO MODIFIER -59.
XE SEPARATE ENCOUNTER, A SERVICE THAT IS DISTINCT BECAUSE IT OCCURRED DURING A SEPARATE ENCOUNTER
XP SEPARATE PRACTITIONER, A SERVICE THAT IS DISTINCT BECAUSE IT WAS PERFORMED BY A DIFFERENT PRACTITIONER
XS SEPARATE STRUCTURE, A SERVICE THAT IS DISTINCT BECAUSE IT WAS PERFORMED ON A SEPARATE ORGAN/STRUCTURE
XU UNUSUAL NON-OVERLAPPING SERVICE, THE USE OF A SERVICE THAT IS DISTINCT BECAUSE IT DOES NOT OVERLAP USUAL COMPONENTS OF THE MAIN SERVICE
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ICD-10-CM Codes that Support Medical Necessity

Group 1

(191 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 17311, 17312, 17313, 17314, and 17315.

Group 1 Codes
Code Description
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified
C21.1 Malignant neoplasm of anal canal
C30.0 Malignant neoplasm of nasal cavity
C31.0 Malignant neoplasm of maxillary sinus
C31.2 Malignant neoplasm of frontal sinus
C43.0 Malignant melanoma of lip
C43.10 Malignant melanoma of unspecified eyelid, including canthus
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.20 Malignant melanoma of unspecified ear and external auricular canal
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.30 Malignant melanoma of unspecified part of face
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.60 Malignant melanoma of unspecified upper limb, including shoulder
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.70 Malignant melanoma of unspecified lower limb, including hip
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C4A.0 Merkel cell carcinoma of lip
C4A.10 Merkel cell carcinoma of unspecified eyelid, including canthus
C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus
C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus
C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus
C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus
C4A.20 Merkel cell carcinoma of unspecified ear and external auricular canal
C4A.21 Merkel cell carcinoma of right ear and external auricular canal
C4A.22 Merkel cell carcinoma of left ear and external auricular canal
C4A.30 Merkel cell carcinoma of unspecified part of face
C4A.31 Merkel cell carcinoma of nose
C4A.39 Merkel cell carcinoma of other parts of face
C4A.4 Merkel cell carcinoma of scalp and neck
C4A.51 Merkel cell carcinoma of anal skin
C4A.52 Merkel cell carcinoma of skin of breast
C4A.59 Merkel cell carcinoma of other part of trunk
C4A.60 Merkel cell carcinoma of unspecified upper limb, including shoulder
C4A.61 Merkel cell carcinoma of right upper limb, including shoulder
C4A.62 Merkel cell carcinoma of left upper limb, including shoulder
C4A.70 Merkel cell carcinoma of unspecified lower limb, including hip
C4A.71 Merkel cell carcinoma of right lower limb, including hip
C4A.72 Merkel cell carcinoma of left lower limb, including hip
C4A.8 Merkel cell carcinoma of overlapping sites
C4A.9 Merkel cell carcinoma, unspecified
C44.01 Basal cell carcinoma of skin of lip
C44.02 Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C44.111 Basal cell carcinoma of skin of unspecified eyelid, including canthus
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.121 Squamous cell carcinoma of skin of unspecified eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.131 Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus
C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
C44.191 Other specified malignant neoplasm of skin of unspecified eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C44.211 Basal cell carcinoma of skin of unspecified ear and external auricular canal
C44.212 Basal cell carcinoma of skin of right ear and external auricular canal
C44.219 Basal cell carcinoma of skin of left ear and external auricular canal
C44.221 Squamous cell carcinoma of skin of unspecified ear and external auricular canal
C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal
C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal
C44.291 Other specified malignant neoplasm of skin of unspecified ear and external auricular canal
C44.292 Other specified malignant neoplasm of skin of right ear and external auricular canal
C44.299 Other specified malignant neoplasm of skin of left ear and external auricular canal
C44.310 Basal cell carcinoma of skin of unspecified parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.320 Squamous cell carcinoma of skin of unspecified parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.390 Other specified malignant neoplasm of skin of unspecified parts of face
C44.391 Other specified malignant neoplasm of skin of nose
C44.399 Other specified malignant neoplasm of skin of other parts of face
C44.41 Basal cell carcinoma of skin of scalp and neck
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.510 Basal cell carcinoma of anal skin
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.520 Squamous cell carcinoma of anal skin
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.590 Other specified malignant neoplasm of anal skin
C44.591 Other specified malignant neoplasm of skin of breast
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C44.611 Basal cell carcinoma of skin of unspecified upper limb, including shoulder
C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder
C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder
C44.621 Squamous cell carcinoma of skin of unspecified upper limb, including shoulder
C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder
C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder
C44.691 Other specified malignant neoplasm of skin of unspecified upper limb, including shoulder
C44.692 Other specified malignant neoplasm of skin of right upper limb, including shoulder
C44.699 Other specified malignant neoplasm of skin of left upper limb, including shoulder
C44.711 Basal cell carcinoma of skin of unspecified lower limb, including hip
C44.712 Basal cell carcinoma of skin of right lower limb, including hip
C44.719 Basal cell carcinoma of skin of left lower limb, including hip
C44.721 Squamous cell carcinoma of skin of unspecified lower limb, including hip
C44.722 Squamous cell carcinoma of skin of right lower limb, including hip
C44.729 Squamous cell carcinoma of skin of left lower limb, including hip
C44.791 Other specified malignant neoplasm of skin of unspecified lower limb, including hip
C44.792 Other specified malignant neoplasm of skin of right lower limb, including hip
C44.799 Other specified malignant neoplasm of skin of left lower limb, including hip
C44.81 Basal cell carcinoma of overlapping sites of skin
C44.82 Squamous cell carcinoma of overlapping sites of skin
C44.89 Other specified malignant neoplasm of overlapping sites of skin
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.019 Malignant neoplasm of nipple and areola, unspecified female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.029 Malignant neoplasm of nipple and areola, unspecified male breast
C51.0 Malignant neoplasm of labium majus
C51.1 Malignant neoplasm of labium minus
C52 Malignant neoplasm of vagina
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C63.2 Malignant neoplasm of scrotum
D00.01 Carcinoma in situ of labial mucosa and vermilion border
D03.0 Melanoma in situ of lip
D03.10 Melanoma in situ of unspecified eyelid, including canthus
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.20 Melanoma in situ of unspecified ear and external auricular canal
D03.21 Melanoma in situ of right ear and external auricular canal
D03.22 Melanoma in situ of left ear and external auricular canal
D03.30 Melanoma in situ of unspecified part of face
D03.39 Melanoma in situ of other parts of face
D03.4 Melanoma in situ of scalp and neck
D03.51 Melanoma in situ of anal skin
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D03.60 Melanoma in situ of unspecified upper limb, including shoulder
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
D03.70 Melanoma in situ of unspecified lower limb, including hip
D03.71 Melanoma in situ of right lower limb, including hip
D03.72 Melanoma in situ of left lower limb, including hip
D03.8 Melanoma in situ of other sites
D04.0 Carcinoma in situ of skin of lip
D04.10 Carcinoma in situ of skin of unspecified eyelid, including canthus
D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
D04.20 Carcinoma in situ of skin of unspecified ear and external auricular canal
D04.21 Carcinoma in situ of skin of right ear and external auricular canal
D04.22 Carcinoma in situ of skin of left ear and external auricular canal
D04.30 Carcinoma in situ of skin of unspecified part of face
D04.39 Carcinoma in situ of skin of other parts of face
D04.4 Carcinoma in situ of skin of scalp and neck
D04.5 Carcinoma in situ of skin of trunk
D04.60 Carcinoma in situ of skin of unspecified upper limb, including shoulder
D04.61 Carcinoma in situ of skin of right upper limb, including shoulder
D04.62 Carcinoma in situ of skin of left upper limb, including shoulder
D04.70 Carcinoma in situ of skin of unspecified lower limb, including hip
D04.71 Carcinoma in situ of skin of right lower limb, including hip
D04.72 Carcinoma in situ of skin of left lower limb, including hip
D04.8 Carcinoma in situ of skin of other sites
D07.1 Carcinoma in situ of vulva
D07.4 Carcinoma in situ of penis
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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N/A

Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
12/11/2023 R2

Article revised and published on 03/07/2024 effective for dates of service on and after 12/11/2023 to add ICD-10-CM code D07.1 to Group 1 ICD-10-CM codes that support medical necessity. This revision is in response to an inquiry. 

08/15/2023 R1

Article revised and published on 09/28/2023 effective for dates of service on and after 08/15/2023 to add ICD-10-CM code D00.01 to Group 1 ICD-10-CM codes that support Medical Necessity in response to an inquiry. 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33689 - Mohs Micrographic Surgery (MMS)
Related National Coverage Documents
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SAD Process URL 2
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