I have Basal Cell Carcinona (BCC) in the face (upper maxilla ), and it was removed on November 22, 2008. However, the surgeon did an incomplete primary excision and the biopsy showed positive margins for BCC. I did some research, and the Mohs Micrographic Surgery (MMS) is a good option for the recurrent BCC. Since I don't have insurance coverage in the US, what is the average cost of MMS?
How Much Does Mohs Surgery Cost?
Doctor Answers 11
It depends on several factors.
Though I am not at liberty to discuss my charges for certain procedures, I can tell you that for a typical Mohs case with 2 layers on the face with a relatively simple closure of the wound, Medicare charges approximately $1,500.
Most dermatologists charge rates that are comparable to Medicare or may charge you a flat rate for the entire procedure. That being said, the range is considerable and without evaluating you, there would be no way to give you an accurate estimate. The charges are usually based on the number of stages required to remove the entire tumor, and the complexity of the closure of the resulting defect. A small to medium-sized defect of the maxilla likely would not require a fancy flap or graft closure.
I agree with you that Mohs micrographic surgery is by far the best approach to a recurrent basal cell on the face. Good luck.
Mohs surgery costs depends on complexity and repair
The cost for Mohs surgery varies by location on the body, geographical area, and surgeon. But the larger determinants are:
1. How many layers will it take to clear the tumor?
The Mohs procedure is billed according to the number of layers, or how many times the tissue has to be cut out and processed to achieve clear margins. Your Mohs surgeon will try to balance clearing the tumor in as few layers as possible while also trying to spare as much healthy tissue as possible.
Depending on the complexity of the tumor and how long it has been there, this can be as few a 1 or as many as 7-10 layers, but is usually between 1-3 layers.
2. What type of repair is performed?
No repair, which is sometimes the best option, costs nothing. A linear repair is more expensive, and flaps and grafts (or a combination) cost the most.
Your Mohs surgeon will work with you to choose the best option for you depending on your activity level and cosmetic expectations, hopefully without regard to the cost.
There are cheaper ways to treat skin cancer, but not better. For many cancers, Mohs is also the most cost effective in the long run because the recurrence rate is lower.
Multiple factors determine the cost of Mohs
The best way to address your question is by seeing a Mohs surgeon in consultation. The physician can better evaluate your condition and determine the complexity of the procedure as well as the reconstruction that might be needed.
No one knows how many stages of Mohs surgery you will need and the cost is proportional to the number of stages as each stage requires further laboratory analysis. The cost of the procedure also depends on the type of repair done on the defect once the cancer is removed.
Reconstruction can be a side-to-side closure or may require a skin graft or a skin flap. If a Mohs defect were allowed to heal with dressing changes, without surgery, the cost of the overall procedure would be less. With one stage of Mohs and some repair, the minimum average cost would be $1,000 or more.
Some procedures involve many stages and elaborate reconstruction but, as most Mohs surgery is done in an office setting, the cost is much less than if it were done in a hospital.
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The Cost of Mohs Surgery
- The number of stages needed
- The reconstruction type
- The location of the body that is impacted
Cost of Mohs Micrographic Surgery
The cost of Mohs Micrographic Surgery depends on number of stages required to achieve clear margins in the surgical site where a basal cell carcinoma or a squamous cell carcinoma has been biopsied. In addition, there may be additional expense related to the reconstructive repair. If you do not have insurance, seek out a Mohs Micrographic Surgeon who is willing to minimize your financial jeopardy and give you a flat fee for the entire procedure from the beginning to the end.
Cost of Mohs Surgery
Costs vary by dermatologist and by geographic area. However, it is standard that cost is per "stage". This is the way Medicare compensates physicians for Mohs surgery. The fee per stage includes the cost of the Mohs surgeon not only removing the cancerous tissue, but also mapping it, sectioning it, marking it and then working with a histotechnician to create frozen sections of the tissue.
Lastly, it also includes the Mohs surgeon reading the sections to see if all the tumor is removed. If another pathologist is "reading " the frozen section and you are billed for another physician in addition to the Mohs surgeon, then you are not receiving Mohs surgery and should not be called such. This is because Mohs surgery includes the pathology and by definition the Mohs surgeon is acting as the pathologist as well as the surgeon. Lastly, the repair of the surgical defect is a separate fee.
Cost of Mohs surgery
The charge for Mohs surgery is as follows:
1. First layer. This cost INCLUDES taking the first skin specimen, the processing of slides, reading the slides and mapping of the tumor. The only variable in this charge is whether it is taking place on the scalp, face, neck vs. the arms, trunk and lower extremities. Generally, most doctors accept insurance for Mohs. I cannot comment on the price for those who do not but this is a reasonable question to ask any Mohs surgeon in consultation. By definition, a Mohs surgeon is both the surgeon and the pathologist. There is NO separate charge for pathology. If there is, you are not going to an approved Mohs surgeon.
2. Second layer. Again, the cost includes all of the components of the first layer. This layer is typically less expensive because it does not require the same tray set-up etc. from scratch.
3. Repair. Completely depends on the type of repair you are having. A straight line repair costs less than a flap.
There are many Mohs surgeons in the country who are excellent and accept insurance. To find a Mohs College surgeon near you, visit the Mohs College website.
Many factors involved in mohs cost
The cost of MOHS skin cancer excision and reconstruction depends on several factors. There are 3 factors that contribute to the overall cost. For MOHS surgery, you will pay for: 1. excision, 2. pathology reading, and 3. reconstruction.
The excision and pathology cost increase as the number of "levels" increase. A level is added each time the doctor has to go back and take more tissue until all of the cancer is removed.
The cost of the reconstruction depends on the size of the wound, how many layers of stitches are needed, if flaps (moving larger areas of skin around) are necessary and the overall complexity of the procedure.
Mohs surgery cost depends on complexity of the case
The cost of your surgery will vary depending on the complexity of the of the case. The advantage of Mohs surgery is that when the surgery is done, you will know immediately that the surgeon has removed all the remaining tumor and this can be done with a 99% certainty in most Mohs cases.
Please be advised that with your initial excision, since it was not done by Mohs surgery, less than 1% margin examination was performed. Therefore, you are lucky that they did detect residual basal cell carcinoma, and this time around, Mohs surgery will be well worth the investment.
In addition, if your surgeon is Fellowship trained in Mohs surgery, they will also likely be experts in reconstruction and be able to repair the excision immediately with optimal cosmetic outcome.
It depends on the number of excisions required plus the closure
Moh's would be considered a medically necessary procedure and as such should be covered by health insurance. So would the wound reconstruction after excision of the BCC. The number of excisions it takes to clear the tumor usually determines the cost of the Moh's treatment in addition to the complexity of the closure.
There is no way to give you cost estimates in your situation. All I can recommend is that you find an excellent Moh's performing dermatologist in your area and ask.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.