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Mohs Micrographic Surgery Volume and Payment Patterns Among Dermatologists in the Medicare Population, 2013

Johnstone, Cameron, AB*; Joiner, Keith A., MD, MPH*,†; Pierce, John, MD; Krouse, Robert S., MD§,∥,¶

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1199–1203
doi: 10.1097/COC.0000000000000448
Original Articles: Cutaneous

Objectives: Mohs micrographic surgery (MMS) has expanded markedly in recent years but there is limited information on volume, practice patterns or reimbursement. This study characterizes MMS utilization in the Medicare population.

Materials and Methods: We analyzed the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013 data set for provider service volume and reimbursement for dermatologists who did and did not perform MMS procedures.

Results: Total Medicare-funded MMS procedures increased 25% from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MMS had significantly more average services per provider (5419.4 vs. 3627.1, r=0.16, P<0.0001), were reimbursed significantly more in average total procedure-related compensation ($475,883.64 vs. $144,564.74, r=0.49, P<0.0001) than dermatologists who did not perform MMS, and made up 71.3% of the top decile of dermatologists ranked by total reimbursement received from Medicare. Total MMS service volume and reimbursement was concentrated among a subset of providers. Among MMS providers, a higher volume of MMS procedures was correlated with a greater likelihood of performing procedures on lesions located on the trunk, arms or legs (r=0.27, P<0.001).

Conclusions: In 2013 reimbursement for MMS comprised almost 19% of the amount reimbursed by Medicare Part B Fee For Service to dermatologists and greater than half a percent of the total amount reimbursed to all physicians participating in the program. Further studies incorporating clinical and outcomes data are needed to evaluate appropriate utilization of this procedure.

*College of Medicine

Department of Economics, Eller College of Management, University of Arizona

Southern Arizona Veterans Affairs Health Care System, Tucson, AZ

§Leonard Davis Institute of Health Economics

Department of Surgery, Perelman School of Medicine, University of Pennsylvania

Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA

C.J., K.A.J., J.P., R.S.K.: had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, study concept and design, acquisition, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. Obtained funding: not applicable. R.S.K.: administrative, technical or material support. K.A.J., J.P., and R.S.K.: study supervision.

The authors declare no conflicts of interest.

Reprints: Cameron Johnstone, AB, College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724. E-mail:

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