CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 17311

Mohs Micrographic Surgery, First Stage (Head/Neck/Hands/Feet/Genitalia)

CPT 17311 is the first stage of Mohs micrographic surgery on the head, neck, hands, feet, or genitalia. It is performed over 659,000 times per year on Medicare beneficiaries. Providers charge an average of $1,491.02 for the first stage alone (2.2x markup over Medicare's $667.02 office rate). However, the first stage is rarely the total bill. Most cases require 1 to 3 stages, and wound closure is billed separately. The complete cost of a Mohs case with repair typically ranges from $2,000 to $5,000 or more. The surgeon acts as both surgeon and pathologist, which is why the work RVU (6.05) is among the highest for outpatient procedures.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 17311 at a Glance

Average provider charge (first stage): $1,491.02
Medicare rate (office): $667.02
Medicare rate (facility): $286.91
Typical markup: 2.2x over Medicare office rate

Additional stages (17312): $300 to $500+ each
Wound repair (separate): $500 to $2,000
Total case cost: $2,000 to $5,000+
Beneficiaries (2023): 659,425

How the Medicare Rate Is Calculated

Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by the national conversion factor of $33.4009 (2026). For Mohs surgery, the work RVU is exceptionally high (6.05) because the surgeon is performing two roles simultaneously: removing tissue and examining it under a microscope as a pathologist. The practice expense is also high because Mohs requires an on-site lab with specialized equipment.

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Surgeon + pathologist combined role	6.05	6.05
Practice Expense RVU	On-site lab, cryostat, histotechnologist, supplies	13.33	1.95
Malpractice RVU	Professional liability (surgical procedure)	0.59	0.59
Total RVU		19.97	8.59
x $33.4009	2026 conversion factor	$667.02	$286.91

This is only the first stage: Most Mohs cases require 1 to 3 stages to achieve clear margins. Each additional stage (CPT 17312) adds approximately $300 to $500. After the cancer is fully removed, the wound must be closed. Wound repair (CPT codes 12031 through 14302) is billed separately and can add $500 to $2,000 depending on whether a simple closure, flap, or skin graft is needed. The total bill for a complete Mohs case typically ranges from $2,000 to $5,000+.

Medicare Rate by State

Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). Because Mohs surgery has an extremely high practice expense component (13.33 RVUs for the on-site lab), geographic variation is substantial. The same first stage pays $594.68 in Arkansas versus $788.15 in Alaska.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting, First Stage)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$691.00	$1,491.02	2.2x
California (Los Angeles)	$750.16	$1,491.02	2.0x
New York (Manhattan)	$763.62	$1,491.02	2.0x
Florida (Fort Lauderdale)	$688.73	$1,491.02	2.2x
Ohio	$628.44	$1,491.02	2.4x
Mississippi	$599.99	$1,491.02	2.5x
Arkansas	$594.68	$1,491.02	2.5x
Alaska	$788.15	$1,491.02	1.9x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $1,491.02 is the 2023 national average from CMS utilization data for the first stage only. Additional stages and wound repair are billed separately.

What Insured Patients Actually Pay for Mohs Surgery

Mohs surgery is a multi-component procedure, so your total bill includes the first stage, additional stages, and wound repair. Each is billed separately. Your insurer has a negotiated rate for each code. Here is what patients typically owe for a complete Mohs case (2 stages plus intermediate repair):

Your Situation	Typical Total Out-of-Pocket	How It Works
Coinsurance plan (deductible met)	$400 to $1,000	20% of negotiated rates for all components combined
Copay plan (surgical copay)	$100 to $500	Flat surgical copay (one copay for the entire case)
High-deductible plan (deductible NOT met)	$2,000 to $5,000	Full negotiated rate until your deductible is met
Medicare Part B (2 stages + repair)	$200 to $400	20% of Medicare-approved amounts for all components
Medicaid	$0 to $10	Minimal or no cost-sharing in most states

Key insight: the number of stages is unpredictable. Your surgeon cannot know in advance how many stages will be needed. Each stage requires removing tissue, processing it in the on-site lab, and examining margins under the microscope. If margins are not clear, another stage is performed. Average is 1.7 stages, but complex or recurrent tumors may need 4 or more. Ask your surgeon about the typical number of stages for your tumor type and location to estimate your total cost.

Should You Use Insurance or Pay Cash for Mohs Surgery?

Mohs surgery is expensive enough that using insurance almost always makes financial sense, even if your deductible is not met. The total negotiated rate for a complete case ($2,000 to $4,000) will likely push you significantly toward or past your deductible, providing benefits for any future care that year.

Why Insurance Almost Always Wins Here

Total case cost is high enough to make significant deductible progress
If you have multiple skin cancers (common), you need deductible credit
Negotiated rate is typically lower than self-pay rate for surgery
Unpredictable number of stages makes upfront cash pricing difficult

Cost Reduction Strategies

Confirm your Mohs surgeon is in-network before the procedure
Ask if the surgeon does their own repairs (some refer to plastic surgeons, adding a separate bill)
Schedule early in the year if you expect to need multiple skin cancer procedures
Ask about simple excision (17260-17286) as an alternative for low-risk tumors on the trunk

When is Mohs necessary vs. standard excision? Mohs surgery is the standard of care for skin cancers on the face, ears, nose, eyelids, lips, hands, feet, and genitalia because it preserves the maximum healthy tissue while achieving the highest cure rate (99%). For skin cancers on the trunk or extremities (away from critical structures), a standard excision (with wider margins) may be equally effective and costs significantly less. Discuss with your dermatologist whether your tumor location truly requires Mohs.

Common Billing Problems with Mohs Surgery

Excessive number of stages billed

The average Mohs case requires 1.7 stages. If your bill shows 4 or more stages for a small basal cell carcinoma, it may warrant review. While some tumors genuinely require many stages (aggressive histological subtypes, recurrent tumors, perineural invasion), an unusually high stage count on a routine tumor should be questioned. You have the right to request the pathology slides and operative report to verify each stage was medically necessary.

Separate bill from a different surgeon for wound repair

Some Mohs surgeons remove the cancer but refer wound closure to a plastic surgeon or facial plastic surgeon. This results in two separate surgeon bills (one for Mohs, one for repair). While this can produce excellent cosmetic results, it also significantly increases the total cost because two surgeons are billing independently. Ask before your procedure whether your Mohs surgeon performs their own repairs or refers out, and confirm that the repair surgeon is also in-network.

Billing 17311 for trunk/extremity locations

CPT 17311 is specifically for the head, neck, hands, feet, and genitalia. Mohs surgery on the trunk or extremities uses CPT 17313, which has a slightly lower reimbursement rate. If your Mohs surgery was performed on an area like the back, arm, or leg but is coded as 17311, it may be an upcoding error. Check that the anatomical location matches the code used.

Unexpected pathology charges

The Mohs surgery code (17311/17312) already includes the pathology component because the Mohs surgeon examines the tissue themselves. If you see a separate pathology bill (88305, 88331) for tissue examined during the Mohs procedure, this may be duplicate billing. The only legitimate additional pathology charge is if a separate specimen is sent to an outside lab for additional evaluation (such as checking for perineural invasion on permanent sections), which should be explained to you.

Related Skin Surgery Codes

Code	Description	Medicare (Office)	Avg. Charge
17311	Mohs, first stage, head/neck/hands/feet	$667.02	$1,491.02
17312	Mohs, each additional stage	$380.00	$750.00
17313	Mohs, first stage, trunk/extremities	$590.00	$1,300.00
11602	Excision, malignant lesion, 1.1 to 2.0 cm (trunk)	$195.00	$500.00
14060	Adjacent tissue transfer, nose/ear/eyelid (repair)	$680.00	$1,800.00

Frequently Asked Questions

How much does Mohs surgery cost without insurance?

The first stage of Mohs surgery (CPT 17311) averages $1,491 without insurance. However, most cases require 1 to 3 stages, and wound closure is billed separately. The total cost for a complete Mohs case with repair typically ranges from $2,000 to $5,000 or more depending on the number of stages needed and the complexity of the repair. Medicare pays $667.02 for the first stage in an office setting. Some dermatology practices offer bundled cash pricing, but this is less common for Mohs given the unpredictable number of stages.

Why is Mohs surgery billed in stages?

Mohs surgery removes skin cancer one thin layer at a time, examining each layer under a microscope during the procedure. The first stage (CPT 17311) includes removal and microscopic examination of the first tissue specimen. Each additional stage (CPT 17312) adds $300 to $500+ for removing and examining another layer. The surgeon cannot predict how many stages will be needed until the margins are clear of cancer cells. This layer-by-layer approach achieves a 99% cure rate while preserving the maximum amount of healthy tissue, which is critical on the face and other cosmetically sensitive areas.

Does insurance cover Mohs surgery?

Yes, most insurance plans and Medicare cover Mohs surgery when medically necessary for skin cancer removal. It is considered the standard of care for basal cell and squamous cell carcinomas in cosmetically or functionally sensitive areas (face, ears, nose, eyelids, lips, hands, genitalia). With Medicare Part B, you pay 20% of the approved amount after your deductible, which is approximately $133 for the first stage. Prior authorization is not typically required for Mohs on the head and neck, but some plans may require it for other locations.

What additional charges come with Mohs surgery beyond the first stage?

Beyond the first stage (CPT 17311, $1,491 average charge), expect: additional stages at $300 to $500 each (CPT 17312, average 0.7 additional stages per case), wound closure/repair billed separately ($500 to $2,000 depending on complexity, using CPT codes ranging from 12031 for simple layered closure to 14302 for complex tissue rearrangement), and possibly a separate pathology charge if specimens are sent to an outside lab. A complete Mohs case on the nose with a local flap repair could total $3,000 to $5,000+ in provider charges.

Need Help Lowering a Medical Bill?

CareRoute Bill Defense is a done-for-you bill reduction service. We analyze the codes on your bill, identify overcharges and coding errors, and apply negotiation and reduction strategies on your behalf. If you received a Mohs surgery bill that seems too high, we can help.

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