Mohs surgery cost per stage: the 2026 Medicare stage table

Stage, block, repair: the three kinds of Mohs line

The CMS correct coding manual describes Mohs micrographic surgery, CPT codes 17311 through 17315, as a procedure in which a single physician performs both the surgery and the pathologic examination of the specimens. For billing, that one sentence explains most of the code structure. The surgeon removes a layer of tissue, processes and reads it, and if more removal is needed, takes another layer. Each round is a stage, and the code set is built so that the first round and every later round are separate lines.

The first stage carries one of two primary codes, chosen by where on the body the surgery is. The CMS short descriptors in the RVU26D file abbreviate the groupings: 17311 is "Mohs 1 stage h/n/hf/g", the head, neck, hands, feet and genitalia, and 17313 is "Mohs 1 stage t/a/l", the trunk, arms and legs. Each later stage is an add-on: 17312 for the first group and 17314 for the second. A fifth code, 17315, is an add-on for each additional tissue block within a stage, beyond the number of blocks the stage code itself covers.

CMS PFS RVU26D (October 2026 release) and GPCI2026, Michigan Locality 01, CY2026 conversion factor $33.40. Office means the nonfacility amount, facility means the surgeon's amount when a hospital bills separately. Computed October 31, 2026. One locality's Medicare anchors; a bill can differ.

Two fields in the last columns matter for the arithmetic later. The global days field reads 000 for the first-stage codes, which the RVU26D documentation defines as a minor procedure whose related preoperative and postoperative work on the day of the procedure is included in the payment, with evaluation and management on that day generally not payable. The add-ons read ZZZ, defined as a code related to another service and always included in that service's global period. An add-on is never billed alone: a 17312 line without a 17311 line on the same claim is a coding error.

The multiple procedure indicator is the second field. The first-stage codes carry indicator 2, which means Medicare's standard multiple surgery rules apply when another procedure with indicator 1, 2 or 3 is done the same day. The add-ons carry indicator 0, meaning no multiple procedure reduction applies to them. Stage add-ons are therefore paid at their full fee schedule amount however many there are, while the first stage can itself be cut in half when a higher-valued repair is billed beside it. That reversal is worked through in its own section below.

The counting unit is the stage, not the minute and not the size of the lesion. A case that clears in one stage bills one 17311 line. A case that needs a fourth layer bills 17311 plus three units of 17312. Nobody can know before the surgery how many stages there will be, which is why a quote for Mohs surgery that gives one number without saying how many stages it assumes is incomplete. Asking for the price per stage, and separately for the repair, turns that single number into a formula you can check against the bill.

Why the surgeon's slides carry no 88305

After an ordinary skin biopsy, a second bill usually follows from a pathology laboratory, priced per specimen under CPT 88305. Our guide to the pathology bill after a biopsy shows how those units add up. Mohs surgery works differently, and the CMS National Correct Coding Initiative Policy Manual, chapter III, revision dated January 1, 2026, says so in section F.

The manual states that the Mohs codes include skin biopsy and excision services (CPT 11102 to 11107, 11600 to 11646 and 17260 to 17286) and pathology services (88300 to 88309 and 88329 to 88332), and that reporting those codes in addition to the Mohs codes is inappropriate. In plain terms: the surgeon who cuts, maps, processes and reads each stage is paid for all of that through the stage code. There is no 88305 for each layer, and no separate frozen section line for the surgeon's own stage slides.

That inclusion explains why the office rate for a stage is high relative to a simple excision. The RVU26D file gives 17311 a nonfacility practice expense value of 13.33 units against a work value of 6.05. Practice expense is where the cost of the in-office laboratory, the technician and the slide processing sits. When the surgery moves to a hospital, the facility practice expense value drops to 1.95, because the hospital supplies the room and bills for it separately.

The manual also lists the exceptions, and they are the lines that can legitimately appear beside a Mohs stage code:

NCCI Policy Manual for Medicare Services, chapter III, revision 1/1/2026, sections F, K and L. Anchors from CMS PFS RVU26D and GPCI2026, Michigan Locality 01. Checked October 31, 2026.

The diagnostic biopsy exception has a timing condition. The manual allows the biopsy and a frozen section to be reported separately if a suspected skin cancer is biopsied for pathologic diagnosis before proceeding to Mohs surgery. It names modifier 59, XS or XU to mark the biopsy as distinct, and adds that modifier 58 is also acceptable to show that the diagnostic biopsy and the Mohs surgery were staged or planned procedures. Where the diagnosis was already made at an earlier visit, a same-day biopsy line beside the Mohs code is the one to ask about.

Immunohistochemistry is a narrower exception. Section K item 4 deals with a Mohs surgeon who divides a tumor specimen into several pieces, makes a block from each and stains one or more with an antibody stain. The manual says only one unit of 88342 may be reported per specimen, with 88341 added once for each additional different antibody, and states that the unit of service is not each block derived from a single specimen. A statement showing 88342 with as many units as there were blocks is the pattern that rule addresses.

For a person who has had a biopsy, then Mohs surgery weeks later, the result is often two quite different pathology histories. The biopsy visit produced a laboratory bill priced per specimen. The Mohs visit produced stage lines from the surgeon and, if the case was in a hospital, a facility line, but usually no laboratory bill at all for the stages themselves.

One to four stages in the surgeon's office

In the office setting the surgeon's practice owns the laboratory and receives one fee schedule payment covering everything: surgery, processing and reading. The table multiplies the CY2026 Michigan Locality 01 office anchors by a stage count. One to four stages are round inputs picked to show how the total moves; they describe no one's case.

Office (nonfacility) amounts, CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Coinsurance column assumes the 2026 Part B deductible is already met. No repair code included. Computed October 31, 2026.

Each step down the table adds one add-on unit. On the head and neck group, one stage is $664.95, two are $1,065.38, three are $1,465.81 and four are $1,866.24. The gap between rows is always $400.43, the 17312 amount, because the add-on is not reduced and does not change with the stage number. On the trunk and limbs group, four stages come to $1,770.71.

The coinsurance column is 20 percent of the total, which is what the claims manual's general Part B rule leaves to the patient once the deductible is met. For four head and neck stages that is $373.25. A secondary policy may pay some or all of that share, depending on the policy. The column is an anchor for comparing a Medicare summary notice against, not a forecast of anyone's bill.

The trunk and limbs codes are valued slightly lower than the head and neck codes in every row. The RVU26D file gives 17313 a work value of 5.42 against 6.05 for 17311, and 17314 2.98 against 3.22 for 17312. A person who has one site in each group on the same day can see both first-stage codes on one claim; the multiple procedure rules then apply between them, the higher-valued one at full rate and the other at half.

Extra tissue blocks are the other way an office total can grow without another stage. Code 17315 is valued at $79.07 per block in the office setting, an add-on with indicator 0 like the stage add-ons. Three extra blocks on one stage, as an example count, add $237.21. The number of blocks a stage code includes before 17315 applies is set in the CPT descriptor, not in the CMS files used here, so ask the practice how it counts blocks if 17315 appears.

The hospital outpatient version: one line grows, one stays flat

When Mohs surgery is done in a hospital outpatient department, two claims price the same case. The surgeon bills the fee schedule at the facility rate, which is the professional payment alone. The hospital bills the outpatient prospective payment system for the room, staff, supplies and the laboratory processing. Our explainer on how facility fees work covers why a hospital-based service splits this way at all.

The October 2026 OPPS Addendum B assigns 17311 and 17313 to status indicator T, APC 5053, with a national unadjusted payment of $755.08 and a minimum unadjusted copayment of $151.02. The stage add-ons 17312 and 17314 and the block add-on 17315 carry status N. Addendum D1 of the CY2026 final rule defines N as paid under the OPPS with payment packaged into payment for other services, and therefore no separate APC payment. The hospital's line is the same whether the case takes one stage or four.

Surgeon: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, facility amounts. Hospital: CMS OPPS October 2026 Addendum B, national unadjusted payment and minimum unadjusted copayment, before wage-index adjustment. The two are different payment systems, shown side by side, not blended. Checked October 31, 2026.

The setting gap closes and then flips as stages accumulate. At one stage, the hospital total of $1,053.23 is well above the office figure of $664.95, and at two stages it is still higher, $1,212.56 against $1,065.38. By three stages the office figure is the larger one, $1,465.81 against $1,371.89, and at four it is $1,866.24 against $1,531.22. The reason is the packaging: each extra stage adds $400.43 in the office but only $159.33 on the surgeon's facility claim and nothing on the hospital's, a difference of $241.10 per stage. The broader version of this setting comparison, for procedures that can be done in a surgery center or a hospital, is on surgery center versus hospital outpatient cost.

The patient's side follows the same split. The surgeon's 20 percent is computed on the facility rate, $59.63 at one stage and $155.23 at four. The hospital's copayment is a separate amount tied to the APC, $151.02 minimum unadjusted, which is 20 percent of the national payment before the hospital's wage index moves it. The two shares are owed to different organizations and appear on different statements. Our guide to what Medicare patients pay for an outpatient procedure walks through that two-share structure for other common codes.

The facility column in the fee schedule is easy to misread. It is lower than the office column because it is a partial payment, not because the hospital setting is cheaper. Comparing the facility rate for 17311, $298.15, with the office rate, $664.95, without the hospital's $755.08 beside it leaves out more than half of the Medicare total for a one-stage hospital case.

The repair line and the half-price ranking

Section F of chapter III says that repairs, grafts and flaps are separately reportable with the Mohs codes, and section L item 9, which bars repair codes for closing ordinary surgical incisions, makes the exception explicit: simple, intermediate and complex wound repair codes may be reported with Mohs surgery, codes 17311 through 17315. The repair is often done the same day by the same surgeon, so it lands on the same claim as the stages, priced under its own code.

CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; CMS OPPS October 2026 Addendum B, national unadjusted. Four common repair codes shown as examples; many others exist. Checked October 31, 2026.

The repair codes carry multiple procedure indicator 2, like the first-stage codes. The RVU26D documentation spells out the rule for indicator 2: when the procedure is billed on the same day as another procedure with indicator 1, 2 or 3, rank the procedures by fee schedule amount and pay 100 percent for the highest and 50 percent for the next, basing payment on the lower of the actual charge or the reduced fee schedule amount. The stage add-ons, at indicator 0, sit outside the ranking and are paid in full.

With a complex repair, 13132, the ranking is straightforward. Take two head and neck stages plus 13132, done in the office, as the example. The 17311 office amount of $664.95 is higher than the 13132 amount of $463.82, so 17311 is paid in full and 13132 at half, $231.91. Adding 17312 at $400.43, the case totals $1,297.29 in Medicare terms, against $1,529.20 if the three lines were simply added at full value. The 20 percent share after the deductible is $259.46.

The same case in a hospital outpatient department ranks the same way on the surgeon's claim: 17311 at $298.15 outranks 13132 at $260.11, so the surgeon's total is $298.15 plus $159.33 plus $130.06, or $587.54. On the hospital claim, both 17311 and 13132 are status T, which Addendum D1 defines as a procedure with multiple procedure reduction applying. Section 10.5 of chapter 4 of the claims manual says the full amount is paid for the procedure with the highest weight and 50 percent for any other surgical procedure at the same time. APC 5053 at $755.08 outranks APC 5052 at $415.32, so the hospital line is $755.08 plus $207.66, $962.74 national unadjusted.

A flap reverses the order. Adjacent tissue transfer on the nose, eyelids, ears or lips, 14060, is valued at $781.17 in the office, more than 17311. Under the ranking the flap is paid in full and the Mohs first stage drops to half, $332.48. For one extra stage plus the flap, the office total is $781.17 plus $332.48 plus $400.43, which is $1,514.08. On a hospital-based claim the surgeon's figure is $898.11 and the hospital line, with APC 5054 at $2,107.97 outranking APC 5053, is $2,485.51.

The global days column adds one more difference between repairs. An intermediate or complex repair carries a 010 period, so routine follow-up in the next 10 days is part of its payment. The 14060 flap carries 090, which the RVU26D documentation defines as major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount. A follow-up visit billed separately inside that window, for the same surgery, is a line worth a question.

Reading a Mohs statement line by line

Mohs statements are easier to check than most surgical bills, because the operative note records each stage and the repair. Ask the practice or the patient portal for that note and for an itemized statement with codes and units, then match them row by row.

A mismatch becomes a short, specific question: "The operative note records three stages; the statement shows 17312 with three units. Please identify the fourth stage or correct the bill." Put it in writing and keep the date. A hospital statement that shows a separate payment line for 17312 is a different question, because the addendum packages that code; the answer may be that the line lists a charge but no separate payment.

If the numbers still do not reconcile, our line-by-line bill review walks through requesting the full statement and disputing a line. For a Medicare patient, the summary notice is the place to confirm which codes were paid, at what allowed amount, and how much went to the deductible versus coinsurance, before paying either practice.

The deductible on a one-stage day

The 2026 Part B deductible is $283.00, according to Medicare.gov. Because a single Mohs stage in an office is priced above that, the deductible can take a large bite out of a one-stage case early in the year. With nothing yet applied, a one-stage head and neck case at the $664.95 anchor would leave the patient the full $283.00 plus 20 percent of the remaining $381.95, which is $76.39, for a total share of $359.39.

The same person a few months later, with the deductible met at other visits, would owe $132.99 on the same anchor. Nothing about the surgery changed; only the calendar did. The Medicare Summary Notice shows, line by line, how much went to the deductible and how much is coinsurance. Where two statements for similar Mohs cases look very different, the deductible is the first thing to check.

In a hospital outpatient department the deductible applies to the Part B services on both claims, so the order in which the claims are processed decides which statement absorbs it. That can make a surgeon's bill look high and the hospital's low, or the reverse, for the same day. Adding the patient shares on the two statements, then comparing the sum with the anchors in this guide, is the cleaner check than reading either statement alone.

Locality moves the dollars, not the structure

Every fee schedule figure on this page is tied to one Medicare payment locality, Michigan Locality 01 (Detroit), whose geographic indices in the GPCI2026 file are 1.000 for work, 0.965 for practice expense and 1.686 for malpractice. The formula is the work value times the work index, plus the practice expense value times its index, plus the malpractice value times its index, all times the CY2026 conversion factor of $33.40.

For 17311 in the office, the RVU26D file lists 6.05 work, 13.33 practice expense and 0.59 malpractice units. With every index at 1.000, that is 19.97 units, or $667.02 before geographic adjustment, against $664.95 in Michigan Locality 01. Because the practice expense share is large for the office codes, localities with a high practice expense index move the office Mohs figures more than they move the facility figures. CMS publishes a Physician Fee Schedule lookup on its website for anyone who wants their own locality's amounts.

The OPPS figures follow a different adjustment. The national unadjusted payment of $755.08 is moved by the hospital's wage index, and the copayment shifts with it. The stage structure does not change by place: in every locality the add-ons are status N on the hospital side and indicator 0 on the fee schedule side. The relationships in the tables (flat hospital line, growing surgeon line, half-price ranking) hold everywhere, even when the dollar amounts do not.

Plans, self-pay and the quote to ask for

A commercial plan pays its own contracted rate for each Mohs code, and the patient share follows the plan's deductible and coinsurance terms. Many plans base their rates on the same codes and unit counts, so the stage structure on a plan claim usually looks like the Medicare one: a first-stage line, add-on units and a repair. The dollar amounts can be quite different. The explanation of benefits guide shows where the allowed amount and your share appear for each line.

Network status matters less for the pathology here than after a biopsy, because the Mohs surgeon reads the slides. The surprise billing limits in 45 CFR 149.420 attach to non-emergency services by nonparticipating providers at participating facilities, and 45 CFR 149.30 defines those facilities as hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgical centers. A Mohs case in the surgeon's office is outside that facility test. The balance billing guide walks through when the limits apply.

This site has not published a verified self-pay range for Mohs surgery, and the Medicare anchors above are not a substitute for one. A Mohs date booked three or more business days out entitles an uninsured or self-pay patient to a Good Faith Estimate from the provider. Because the stage count is unknown in advance, the useful version of that estimate prices each stage and the repair separately. Our Good Faith Estimate guide lists the required contents and the dispute route when the bill overshoots.

A sentence that covers the pricing gaps, for the practice's billing office: "Please give me your price for CPT 17311 for the first stage, for 17312 for each added stage, for 17315 if extra blocks are counted, and for the repair code you expect, and tell me whether the surgery will be billed in the office or through a hospital." With those numbers, any final stage count turns into a total you can check. The price-by-CPT-code guide explains how to use codes in that kind of request, and the pre-procedure billing checklist lists the other items to cover.

Questions about Mohs stage charges

Fee files, manuals and rules behind the stage table

• CMS, NCCI Policy Manual for Medicare Services, chapter III, Integumentary System, revision date 1/1/2026: section F (Mohs micrographic surgery: included biopsy, excision and pathology codes, the diagnostic biopsy exception and its modifiers, separately reportable repairs, grafts and flaps), section K item 4 (immunohistochemistry units for a Mohs surgeon) and section L item 9 (repair codes reportable with 17311 to 17315). Checked October 31, 2026.
• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release, released 08/26/2026), its documentation of global days and the multiple procedure indicator, and GPCI2026 for Michigan Locality 01 at the $33.40 conversion factor: every office and facility anchor on this page. Computed October 31, 2026.
• CMS, OPPS October 2026 Addendum B: status indicators, APCs, national unadjusted payments and minimum unadjusted copayments for 17311 to 17315, 12051, 12052, 13132, 14060, 11102 and 88331. Checked October 31, 2026.
• CMS, CY2026 OPPS final rule addenda, Addendum D1, definitions of status indicators T and N. Checked October 31, 2026.
• CMS, Medicare Claims Processing Manual, chapter 4, sections 10.1.1 and 10.5 (status indicators and OPPS multiple procedure discounting), and chapter 12, section 40.6 (claims for multiple surgeries). Checked October 31, 2026.
• eCFR, 45 CFR 149.420 and 45 CFR 149.30, balance billing at participating facilities and the definition of health care facility. Checked October 31, 2026.
• Medicare.gov, Medicare costs, 2026 Part B deductible of $283.00. Checked October 30, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill; a practice's charges, a hospital's charges and a plan's allowed amounts can differ widely from them. Confirm your price in writing before service.