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Medicare FFS Pricing Incentivizes Use of Mohs Micrographic Surgery Over Other Skin Cancer Procedures

December 04, 2020

Increased use of Mohs micrographic surgery (MMS) has taken over other skin cancer procedures in the Medicare population and increased spending on skin cancer procedures (JAMA Netw Open. 2020;3[11]:e2025139. doi:10.1001/jamanetworkopen.2020.25139).

The incidence of skin cancer in the United States is increasing, and procedural treatments include MMS, simple surgical excision, and shave excision. Medicare payments vary widely across these procedures, and little is known about how payment variations relate to the use of these procedures.

This study describes recent trends in payment rates, use rates, and overall expenditure for skin cancer procedures in the Medicare Part B population. Researchers grouped the procedures into categories using Healthcare Common Procedure Coding System. Data were collected using the Medicare Physician Supplier and Other Provider Public Use File. The volume of services, number of clinicians, and mean Medicare Part B payments from January 1, 2012 to December 31, 2017 was collected.

During 2012 to 2017, MMS services had the highest mean payment ($378.71; range, $41.24-$466.93) and the use rate increased 21% from 3554 per 100,000 Medicare beneficiaries to 4293 per 100,000 Medicare beneficiaries. Shave excisions had the lowest mean payment ($70.99; range, $15.58-$135.24), but the use rates of simple excision, shave excision, and destruction of malignant lesions all declined during this period. Total spending on skin cancer procedures increased 9%. This was a result of an increase in expenditures for MMS.

“The results of this cohort study suggest that increased use of MMS has displaced use of other skin cancer procedures in the Medicare population,” said study authors. “Medicare payment rates for MMS are more than double those for simple excisions.”—Lisa Kuhns

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