Does Medicare Cover Reconstruction After Mohs Surgery?

Although skin cancer is not as common and is often less serious than some other cancers, it still needs treatment as early as possible. And one of the ways to treat skin cancer is through Mohs surgery.

If this is a type of treatment you are thinking about getting, one of the questions you may have is, “does Medicare cover reconstruction after Mohs surgery?” In this article, we answer that question in clear, plain English.

Does Medicare Cover Reconstruction After Mohs Surgery?

The short answer is no. In most cases, Medicare will not cover the cost of reconstruction after Mohs surgery. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your reconstruction after Mohs surgery.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for reconstruction after Mohs surgery. Medicare considers reconstructive surgery after Mohs surgery as cosmetic surgery. And, most of the time, Original Medicare does not provide coverage for cosmetic surgeries. That is because cosmetic surgeries are not considered medically necessary.

However, the Mohs surgery itself is covered by Original Medicare. For Original Medicare to provide coverage for your Mohs surgery, it must be considered medically necessary. It must also first be ordered by your healthcare provider.

Original Medicare provides coverage Mohs surgery if it will be for treating skin cancer. Original Medicare will still provide coverage for Mohs surgery if it removes some skin that is suspected as cancerous but turns out that it was not.

Part A Coverage

Coverage for Mohs surgery for skin cancer is provided by Medicare Part A if your Mohs surgery for skin cancer takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 60 to 90, Medicare Part A will still provide coverage. However, you will have to pay a copay for each day you are in the hospital during this time. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days. Again, you will have a sizeable copay for each day you are in the hospital.

Part B Coverage

On the other hand, coverage for Mohs surgery for skin cancer is provided by Medicare Part B as it often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of Mohs surgery for skin cancer. You will pay for the remaining 20 percent.

Part C Coverage for Reconstruction after Mohs Surgery

Just like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not provide coverage for the reconstruction after Mohs surgery. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.