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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Medicare guidance says Mohs micrographic surgery (CPT codes 17311-17315) is performed to remove 
complex or ill-defined cutaneous malignancy. A single physician performs both the surgery and pathologic 
examination of the specimen(s). The Mohs micrographic surgery CPT codes include skin biopsy and excision 
services (CPT codes 11102-11107, 11600-11646, and 17260-17286) and pathology services (88300-88309, 
88329-88332). Reporting these latter codes in addition to the Mohs micrographic surgery CPT codes is 
inappropriate. However, if a suspected skin cancer is biopsied for pathologic diagnosis prior to proceeding to 
Mohs micrographic surgery, the biopsy (e.g., CPT codes 11102-11107) and frozen section pathology (CPT 
code 88331) may be reported separately using modifier 59 or -X{SU}, or 58 to distinguish the diagnostic 
biopsy from the definitive Mohs surgery. Although the "CPT Manual" indicates that modifier 59 should be 
used, it is also acceptable to use modifier 58 to indicate that the diagnostic skin biopsy and Mohs micrographic 
surgery were staged or planned procedures. Repairs, grafts, and flaps are separately reportable with the Mohs 
micrographic surgery CPT codes. (CPT codes 11100 and 11101 were deleted January 1, 2019.) You can find 
this guidance in the National Correct Coding Initiative Policy Manual For Medicare Services Chapter 3 
Surgery: Integumentary System, F. Mohs Micrographic Surgery. 
 
Medicare guidance says Medicare will only reimburse for MMS services when the Mohs surgeon acts as 
both surgeon and pathologist. You may not bill Medicare for these procedures if preparation or interpretation of 
pathology slides is performed by a physician other than the Mohs surgeon. 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. Further, the 
physician performing MMS serves both as surgeon and pathologist; performing not only the excision but also 
the histologic evaluation of the specimen(s). CPT Code 17311 - Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, 
microscopic examination of specimens by the surgeon, and histopathologic preparation including routine 
stain(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with 
surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up 
to 5 tissue blocks. CPT Code 17312 - Mohs micrographic technique, including removal of all gross tumor, 
surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of 
specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and 
eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, 
cartilage, bone, tendon, major nerves, or vessels; each additional stage after the first stage, up to 5 tissue blocks 
(list separately in addition to code for primary procedure). You can find this guidance in the Medicare Learning 
Network (MLN) SE1318. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.