Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 11202 | Palmetto GBA | A and B and HHH MAC | SC |
| 11302 | Palmetto GBA | A and B and HHH MAC | VA |
| 11402 | Palmetto GBA | A and B and HHH MAC | WV |
| 11502 | Palmetto GBA | A and B and HHH MAC | NC |
| 10112 | Palmetto GBA | A and B MAC | AL |
| 10212 | Palmetto GBA | A and B MAC | GA |
| 10312 | Palmetto GBA | A and B MAC | TN |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56732 (Billing and Coding: Mohs Micrographic Surgery (MMS)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56732: Billing and Coding: Mohs Micrographic Surgery (MMS) (Billing and Coding, effective 2024-01-31)
- Covered ICD-10-CM codes
- 176
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 5
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| C00.0 | — |
| C00.1 | — |
| C00.3 | — |
| C00.4 | — |
| C00.5 | — |
| C00.6 | — |
| C00.8 | — |
| C30.0 | — |
| C43.0 | — |
| C43.111 | — |
| C43.112 | — |
| C43.121 | — |
| C43.122 | — |
| C43.21 | — |
| C43.22 | — |
| C43.31 | — |
| C43.39 | — |
| C43.4 | — |
| C43.52 | — |
| C43.59 | — |
| C43.61 | — |
| C43.62 | — |
| C43.71 | — |
| C43.72 | — |
Procedure codes: 17311, 17312, 17313, 17314, 17315.
Coverage indications, limitations and medical necessity
Medicare will consider reimbursement for Mohs micrographic surgery (MMS) for accepted diagnoses and indications. Current accepted diagnoses and indications are listed in this LCD. The physician performing the MMS must be trained and highly skilled in MMS techniques, and pathology identification. The physician must document in the patient's medical record that the diagnosis is appropriate for MMS and that MMS is the most appropriate choice as the treatment of the particular lesion.
Medicare is aware that a biopsy of the skin lesion for which Mohs surgery is planned is necessary in order for the physician to determine the exact nature of the lesion(s) to be removed. Occasionally, that biopsy may need to be done on the same day that the Mohs surgery is planned to be done.
No payment will be allowed for the biopsy and pathology of a lesion, which requires removal by the MMS technique, if a biopsy of that lesion has been performed within 60 days prior to MMS. An exception exists when a biopsy has been performed within that period and the biopsy results could not be obtained by the Mohs surgeon using reasonable effort. The clinical record must clearly show that this situation existed.
Current accepted diagnoses and indications for MMS are:
Basal cell carcinomas, squamous cell carcinomas or basalosquamous cell carcinomas in anatomic locations where they are prone to recur:
• Central facial areas, nose and temple areas of the face (the so-called "mask area" of the face), which includes the eyebrows and periorbital areas, the superolateral temple areas, and the preauricular and postauricular areas.
• Lips, cutaneous and vermilion.
• Eyelids.
• The entire external ear and ear canal.
Other skin lesions:
• Angiosarcoma of the skin.
• Keratoacanthoma, recurrent or rapidly growing destructive variants.
• Dermatofibrosarcoma protuberans.
• Malignant fibrous histiocytoma.
• Sebaceous gland carcinoma.
• Microcystic adnexal carcinoma.
• Extramammary Paget's disease.
• Bowenoid papulosis.
• Merkel cell carcinoma.
• Bowen's disease (squamous cell carcinoma in situ).
• Adenoid type of squamous cell carcinoma.
• Rapid growth in a squamous cell carcinoma.
• Longstanding duration of a squamous cell carcinoma.
• Verrucous carcinoma.
• Atypical fibroxanthoma.
• Leiomyosarcoma or other spindle cell neoplasms of the skin.
• Adenoid Cystic carcinoma of the skin.
• Erythroplasia of Queyrat.
• Oral and central facial, and paranasal sinus neoplasm.
• Apocrine carcinoma of the skin.
• Malignant melanoma or melanoma in situ (facial, auricular, genital and digital) when anatomical or technical difficulties do not allow conventional excision with appropriate margins.
• Rare, biopsy-proven skin malignancies not otherwise addressed in this section.
• Basal cell carcinomas, squamous cell carcinomas or basalosquamous cell carcinomas having one or more of the following features:
• Are recurrent.
• Biopsy proven lesions with aggressive pathology as documented by at least 1 of the following microscopic characteristics:
• Sclerotic.
• Fibrosing.
• Morphea-like.
• Metatypical/infiltrative/spikey shaped cell groups.
• Perineural or perivascular invasion.
• Nuclear pleomorphism.
• High mitotic activity or superficial multicentric.
• Located in the following areas: genitalia, digits or nail unit/periungual.
• Large size (1.0 cm or greater in the non-mask areas of the face and 2.0 cm or greater in other areas).
• Positive margins on recent excision.
• Poorly defined borders.
• Present in the very young (less than 40 years of age).
• Radiation-induced.
• In patients with proven difficulty with skin cancers or who are immunocompromised.
• Basal cell nevus syndrome.
• Present in an old scar (e.g., Marjolin's ulcer).
• Associated with xeroderma pigmentosum or difficulty estimating depth of lesion.
• Laryngeal carcinoma in certain limited clinical situations.
Summary of evidence (opening)
N/A
The contractor cites 7 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2023-11-16
- Last reviewed by the contractor
- 2023-10-10
- MCD version
- 38
- Derived from
- L31749
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Palmetto GBA hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L33436 cover?
Medicare will consider reimbursement for Mohs micrographic surgery (MMS) for accepted diagnoses and indications. Current accepted diagnoses and indications are listed in this LCD. The physician performing the MMS must be trained and highly skilled in MMS techniques, and pathology identification. The physician must document in the patient's medical record that the diagnosis is appropriate for MMS and that MMS is the… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L33436 apply to?
Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L33436?
The companion billing and coding article A56732 lists 176 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L33436?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.