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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.  The rules state that the appropriate use criteria recommendations (supported by AAD/ACMS/ASDSA/ASMS) provide a necessary starting point for consideration of Mohs micrographic surgical treatment of a lesion. However, Mohs Micrographic Surgery is indicated only when the superficial (lateral) or deep margins of the cancer lesion are uncertain clinically AND the likelihood of surgical cure and reconstruction would be compromised without use of immediate microscopic examination of the surgical margins. Though complexity of the lesion (poorly defined borders, suspected deep invasion, recurrent lesion, prior radiation), lesion size/location, and maximum conservation of healthy tissue are to be addressed in the preoperative medical record, the surgeon must address why the lesion will not be (was not) managed by excision or destruction technique.   Current accepted diagnoses and indications for Mohs Micrographic Surgery:       Basal cell carcinomas (BCC), squamous cell carcinomas (SCC), basalosquamous/basosquamous cell carcinomas in anatomic locations H and M.         Area H: "Mask areas" of face (central face, eyelids [including inner/outer canthi], eyebrows, nose, lips [cutaneous/mucosal/vermillion], chin, ear and periauricular skin /sulci, temple), genitalia (including perineal and perianal), hands, feet, nail units, ankles, and nipples/areola         Area M: Cheeks, forehead, scalp, neck, jawline, pretibial surface     Basal cell carcinomas (BCC), squamous cell carcinomas (SCC), or basalosquamous/basosquamous cell carcinomas that are in anatomic locations H, M, and L (trunk and extremities) regardless of subtype, size, or depth arising in:         Prior radiated skin         Traumatic scar         Area of osteomyelitis         Area of chronic inflammation/ulceration         Patients with genetic syndromes     Certain recurrent skin cancers:         Recurrent aggressive BCC, nodular BCC, superficial (except area L) BCC of any size, or unexpected positive margin on recent excision (healthy or immunocompromised patients with genetic syndromes)         Recurrent aggressive SCC, verrucous SCC, KA-type SCC (not central facial), in situ/Bowen SCC of any size or unexpected positive margin on recent excision (healthy or immunocompromised patients, or patients with genetic syndromes)      Lentigo maligna, melanoma in situ, non-lentigo maligna - primary or locally recurrent in Areas H, M, L when clinical staging, work-up, and surgical treatment consistent with NCCN guidelines     Less common skin cancers:         Adenocystic carcinoma         Adnexal carcinoma         Angiosarcoma         Apocrine/eccrine carcinoma         Atypical Fibroxanthoma         Dermatofibrosarcoma protuberans         Extramammary Paget's Disease         Leiomyosarcoma         Malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma         Merkel cell carcinoma         Microcystic adnexal carcinoma         Mucinous carcinoma         Sebaceous carcinoma  You can find this information in the Local Coverage Determination (LCD) Mohs Micrographic Surgery (MMS)(L33689).  If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.