Medicare- Does Medicare cover Mohs surgery?

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  • Does Medicare cover Mohs surgery? Find out when Medicare funds Mohs surgery for beneficiaries with skin cancer, how the procedure works and potential risks.

Skin cancer is the most common cancer in America, affecting as many as 1 in 5 U.S. citizens during their lifetimes. You're at an increased risk of developing skin cancer if you regularly allow your skin to burn. 

Skin changes and new moles are often warning signs of skin cancer, and it can spread to other body parts. Fortunately, there are effective surgical treatments to remove the cancerous cells and prevent them from spreading.

One of the least invasive surgical options for skin cancer is a procedure called Mohs surgery. Keep reading to find out if Medicare covers Mohs surgery and who is eligible.

Does Medicare Cover Mohs Surgery?

Medicare may cover Mohs surgery if it's medically necessary. Therefore, beneficiaries must be referred for Mohs surgery by their doctors to qualify for Medicare coverage if they have diagnosed or suspected skin cancer. Although Medicare doesn't usually cover the removal of moles or discolored skin for cosmetic reasons, it does not consider Mohs surgery to be cosmetic because it is intended to diagnose and treat cancer.

If you're eligible for Mohs surgery coverage through Medicare, your treatment will be funded through Part B if it's performed as an outpatient procedure and Part A if you receive inpatient treatment. Medicare will only consider paying for Mohs surgery if the same practitioner performs the surgery and pathology analysis. This means that your surgeon must perform the surgery and interpret the results. 

If you require medication to treat your cancer or during or after Mohs surgery, whether you receive drug coverage depends on several factors. Medicare Part B may cover chemotherapy drugs if you require them to treat your cancer alongside Mohs surgery. However, Original Medicare does not cover other drug types. You may be entitled to drug funding if you have a separate Medicare Part D plan or a Medicare Advantage policy incorporating Part D coverage. These plans are provided by private insurers, and the drugs covered by each insurer vary.

What Is Mohs Surgery?

Mohs surgery is normally performed as an outpatient procedure under local anesthetic. The surgeon first injects an anesthetic into the affected area. Once the area is numb, they remove the top layer of cancerous cells with a scalpel and examine them under a microscope while the person waits. 

If necessary, the surgeon injects more local anesthetic and removes another layer of skin for examination. This process is repeated until the surgeon is confident that they have excised all the cancerous tissue. How long the procedure takes depends on the lesion size and how many skin layers need to be removed. 

Once the lesion has been excised, the surgeon will usually close the wound using stitches, or a skin graft if the wound is large. However, it's sometimes necessary to leave the wound open for healing. 

The primary advantage of Mohs surgery compared to many other skin cancer surgeries is that it saves as much healthy tissue as possible to minimize scarring. It's also highly effective, providing a cure rate of 99% for previously untreated skin cancers and 94% for recurrent skin cancers. 

When Is Mohs Surgery Used?

Mohs surgery is an effective treatment for basal and squamous cell carcinomas, but it may also be recommended for less common skin cancer types. It's particularly useful for treating large, aggressive or recurrent skin cancers and cases where the extent of the lesion is unclear on examination. As Mohs surgery preserves as much healthy tissue as possible, it's often used to treat cancers in highly visible areas such as the face. 

What Are the Risks and Side Effects of Mohs Surgery?

All surgery, including Mohs surgery, comes with the risk of bleeding, pain and infection. However, these risks can often be mitigated with appropriate aftercare. 

Mohs surgery also carries the risk of several side effects, such as persistent numbness or nerve pain in the affected area and keloid scarring. Occasionally, the surgery can cause muscle weakness if a nerve supplying a muscle is cut while removing a large lesion. Side effects of Mohs surgery are rare, and the procedure is generally considered a safe skin cancer treatment option.

How Can I Reduce My Risk of Skin Cancer?

One of the primary causes of skin cancer is prolonged and repeated exposure to UV rays from strong sunlight. You can limit your risk by avoiding spending a lot of time in the sun at the hottest times of day and not using tanning beds.

However, it's not always possible to avoid strong sunlight. You can reduce the chances of skin damage by wearing sunblock with an SPF factor of at least 30 and covering up with clothing and a sunhat. Remember to reapply sunblock every couple of hours or after swimming. Check your skin regularly for changes, paying particular attention to moles and see a doctor if you notice anything different. 

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