Mohs surgery challenged by some insurance companies, docs say

April 1, 2010
Karen Nash

Print and broadcast media medical reporter based in Sioux Falls, S.D.

On Call talked to dermatologists across the country and asked them to explain when they believe Mohs surgery is appropriate, whether they consider the surgery overused, and whether they've run into issues with reimbursement.

Key Points

Today, nearly 900 doctors belong to the American College of Mohs Surgery, which means they have performed more than 500 cases of Mohs within a two-year period in an approved Mohs fellowship program.

The technique was designed to ensure that skin cancers were removed in their entirety, with the loss of the least amount of tissue. It's a technique that's been long-accepted as a way to treat particular forms of skin cancer, such as invasive cancers; those occurring near nerves or where the saving of tissue is needed to improve cosmetic results, such as on the face, neck, or hands; recurring cancers; and cancers that occur near scars or have unclear edges.

Just because Mohs surgery has become more commonplace, however, doesn't mean that it is endorsed by all. Doctors say some insurance companies are asking if the procedure is used unnecessarily and are putting up roadblocks to reimbursement.

On Call talked to dermatologists around the country - some who perform Mohs and some who don't. We asked them to explain when they believe Mohs is appropriate, whether they consider the surgery overused, and whether they've run into issues with reimbursement.

"Especially companies that are full-risk programs. They dictate what we can and cannot do," he says. "If a patient has a skin cancer that requires Mohs surgery, they won't let us do Mohs anymore, claiming it's a cosmetic procedure, particularly when it's done in the elderly population.

"I've been told to do what plastic surgeons do: Excise the cancer and send it out for margins," he says. "The carriers say we'll get clear margins on 90 percent of first excisions, and then, if we don't, we can always go back and do it again."

An adjunct professor at the University of South Florida, with 30 years' experience, Dr. Proper says, "The insurance companies contend there's no reason for us to do Mohs, which is a more expensive procedure and they don't want to pay for it, especially when it comes directly out of their pocket in a full-risk system."

Encountering 'barriers'

In Brentwood, Calif., Robert E. Beer, M.D., says that while his insurance companies have not been that blatant, they are creating barriers.

"What's happening now is that insurance companies are classifying Mohs as lab work, so a lot of it becomes a deductible issue," he says. "That makes it difficult for some patients to handle, if they have high deductibles."

Dr. Beer has also had insurance carriers raise objections to the decision to perform Mohs, and he and his staff have worked to find ways around those objections.

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