How Much Does Mohs Surgery Cost in 2026?

Mohs micrographic surgery is the highest-cure-rate treatment for common non-melanoma skin cancers, including basal cell carcinoma and squamous cell carcinoma. The procedure removes cancer one thin layer at a time while the surgeon examines each layer under a microscope in real time, achieving cure rates of 98 to 99 percent for primary tumors. Approximately 1.5 million Mohs procedures are performed in the United States each year, and the procedure is covered under Medicare Part B and most ACA-compliant commercial plans when medically necessary. The 2026 cash price range is wide, from under $1,500 for a single-stage trunk lesion at a private dermatology office to over $12,000 for a three-stage facial reconstruction at a hospital outpatient center.

The cost structure of Mohs surgery differs from most outpatient surgical procedures because the price is not fully knowable before the procedure begins. Each stage adds surgeon time, pathology fees, and potentially facility time. A single-stage case billed at $1,800 can become a three-stage case billed at $4,500 if the first two stages return positive margins. Reconstruction, which is billed separately from the Mohs excision itself, adds another $500 to $4,000 depending on whether simple linear closure, a flap, or a skin graft is needed. Patients requesting a Good Faith Estimate should ask for both the excision estimate and a separate reconstruction estimate, and should understand that the GFE is not a cap on the final bill if unexpected stages are required. The No Surprises Act effective January 2022 gives uninsured patients the right to a written GFE and a dispute pathway if the final bill exceeds the estimate by $400 or more.

This guide covers what Mohs surgery costs without insurance in 2026 by stage and site, what Medicare pays under the 2026 Physician Fee Schedule, how the No Surprises Act applies to dermatology offices and ASCs, how to request a Good Faith Estimate for Mohs surgery, and the billing errors most likely to inflate your final bill. The CMS Medicare coverage database for Mohs surgery is documented at cms.gov and the consumer rights portal for the No Surprises Act is at healthcare.gov. For uninsured patients, comparing the cash price at an independent dermatology office against a hospital outpatient department can save $1,500 to $3,000 on the same procedure.

Mohs Surgery Cost by Site of Service in 2026

The biggest cost driver of Mohs Surgery is the site of service: where the procedure is performed. 2026 CMS price transparency data confirms a 2-3x billing differential between independent centers and hospital outpatient departments.

Why the Same Procedure Is So Much More at a Hospital

The biggest cost driver in a 2026 Mohs surgery quote is the site where the procedure is performed. Dermatologist offices with in-office surgery suites operate with lower overhead than hospital outpatient departments and typically offer the lowest cash prices for uncomplicated single-site cases. Hospital outpatient departments add a facility fee, a separate professional fee, and higher overhead that can push a two-stage procedure from $2,500 at an office to $5,500 at a hospital without any change in surgical outcome. CMS 2026 price transparency data confirms a 2 to 3x billing differential between independent physician office settings and hospital outpatient settings for dermatologic surgical procedures.

Mohs surgery has an important Medicare billing nuance at ASCs. CMS classifies Mohs as an 'office-based procedure', meaning the physician fee under the Physician Fee Schedule is reduced when performed in an ASC (facility fee offset). The total payment to the ASC facility is structured so that the facility component and the physician site-of-service reduction roughly offset each other. In practice, patients pay their standard 20 percent coinsurance on the combined allowed amount regardless of ASC vs. office billing. For self-pay patients, ASC cash quotes are typically higher than a private dermatology office cash quote because the ASC charges a separate facility fee on top of the surgeon's fee.

The chargemaster list price at a hospital outpatient department is almost never the price any patient pays. Insured patients pay their contracted rate, which is typically 40 to 70 percent of the chargemaster. Uninsured patients can request the hospital's self-pay discount policy, which most hospitals publish under CMS price transparency requirements. Asking for the self-pay rate before scheduling can reduce a $5,000 chargemaster quote to $2,500 to $3,500 for a comparable procedure. Independent dermatology offices set their own cash prices and often post them directly or will provide a written quote over the phone.

Mohs Surgery Cost by Stage and Location in 2026

Mohs surgery is billed by stage, not as a single flat fee. The surgeon charges for each stage, the pathology examination of each tissue layer, and any reconstruction. A one-stage case on the trunk costs far less than a three-stage case on the nose. The table below shows estimated 2026 cash prices at a dermatologist office by procedure complexity.

What Medicare Pays for Mohs Surgery

Original Medicare Part B covers Mohs micrographic surgery when medically necessary for the treatment of diagnosed skin cancer, primarily basal cell carcinoma and squamous cell carcinoma. Medicare does not cover Mohs surgery for benign lesions unless cancer is suspected at the time of excision. Under Part B, Medicare pays 80 percent of the approved amount after the 2026 Part B deductible of $283; the beneficiary pays the remaining 20 percent coinsurance. The 2026 Medicare Physician Fee Schedule pays approximately $480 for CPT 17311 (first stage, head, neck, hands, feet, or genitalia) and approximately $413 for CPT 17313 (first stage, trunk, arms, or legs). Each additional stage adds roughly $172 (CPT 17312, high-complexity sites) or $147 (CPT 17314, trunk and extremities) to the Medicare-approved amount.

Medicare Advantage plans cover Mohs surgery as medically necessary under their Part B benefit, but some Medicare Advantage plans require prior authorization before scheduling. Original Medicare does not require prior authorization for Mohs surgery performed in a physician office, but some Medicare Administrative Contractors have Local Coverage Determinations (LCDs) specifying documentation requirements for high-stage or high-frequency Mohs cases. Medigap supplemental plans (Plans C, D, G, F, and N) pay the 20 percent Medicare coinsurance that Original Medicare does not cover, significantly reducing out-of-pocket cost for beneficiaries. Patients on Medicare Advantage should verify their plan's Summary of Benefits for Mohs-specific prior authorization and cost-sharing requirements before scheduling.

Commercial ACA-compliant plan coverage for Mohs surgery follows the same medical necessity standard: covered when the procedure is for diagnosed skin cancer, not for cosmetic removal of benign lesions. ACA-compliant plans subject Mohs surgery to the deductible and coinsurance, typically the same cost-sharing tiers as other outpatient surgical procedures. Patients with high-deductible health plans (HDHPs) may owe the full contracted rate for a Mohs procedure until the deductible is met, which for a family plan in 2026 can range from $1,500 to $7,500. Prior authorization is commonly required by commercial insurers and some Medicare Advantage plans. Failing to obtain prior authorization can result in denial or a significant increase in patient cost-sharing.

Under the No Surprises Act, effective January 1, 2022, any patient who is uninsured or who chooses to pay cash for a Mohs procedure has the right to receive a written Good Faith Estimate from the provider before the procedure. For a Mohs surgery scheduled at least 10 business days out, the provider must furnish the written GFE at least 3 business days before the scheduled service date. For appointments scheduled 3 to 9 business days out, the GFE must arrive at least 1 business day before service. The federal consumer guidance is at healthcare.gov/medical-bill-rights and the dispute portal is at cms.gov/nosurprisesact. The GFE for Mohs surgery should itemize the Mohs excision fee, the expected number of stages, a pathology fee, anesthesia if applicable, the facility fee if applicable, and a separate reconstruction estimate if reconstruction is anticipated.

To request a Good Faith Estimate for Mohs surgery in 2026, follow these steps: (1) Call the dermatology office, ASC, or hospital outpatient center and identify yourself as self-pay or uninsured before scheduling. (2) Request a written Good Faith Estimate that separately itemizes the Mohs surgical fee by expected stage count, pathology fees per stage, the facility component if the procedure is not in-office, and any anticipated anesthesia or reconstruction charges. (3) Provide your ZIP code, the diagnosis code your dermatologist has given (typically a skin cancer ICD-10 code), the expected anatomic site, and any known complexity factors. (4) Confirm the timing rule: if the appointment is 10 or more business days out, the GFE must arrive at least 3 business days before service; if 3 to 9 business days out, 1 business day before. (5) Keep the written GFE. If the final bill exceeds the GFE by $400 or more, you have 120 days from the bill date to file a patient-provider dispute resolution claim through the federal portal at cms.gov/nosurprisesact.

A Good Faith Estimate for Mohs surgery is not a guaranteed final bill. Mohs surgery has a uniquely unpredictable cost structure because the number of stages required depends entirely on intraoperative pathology findings. Common reasons the actual charges exceed the GFE include: unexpected additional stages needed to achieve clear margins, a more complex reconstruction than anticipated after the tumor is fully removed, longer procedure time triggering higher anesthesia charges, pathology blocks beyond the initial estimate, and supplies not in the original estimate such as specialized skin grafting materials. These are legitimate reasons a final bill can exceed a GFE even when the provider prepares the estimate in good faith. If the final bill exceeds the GFE by $400 or more, the patient retains the right to file a patient-provider dispute resolution claim within 120 days of receiving the final bill at the federal portal cms.gov/nosurprisesact.

What Factors Affect Cost

• Number of stages required to achieve clear margins. Each additional stage adds approximately $172 to $800 in surgeon and pathology fees depending on site and practice, and this cannot be known in advance.
• Site of service. A dermatologist office or in-office surgery suite typically costs 30 to 50 percent less than a hospital outpatient department for the same number of stages. For self-pay patients, choosing an independent dermatology practice over a hospital-affiliated center can save $1,500 to $3,000.
• Anatomic location. Head, neck, hands, feet, and genitalia cases (high-complexity sites) carry higher Medicare-approved rates and typically higher cash prices than trunk and extremity cases because of greater surgical complexity and cosmetic significance.
• Reconstruction type billed separately. Simple linear closure adds $300 to $700. An intermediate repair or local flap adds $1,000 to $3,000. A full-thickness skin graft or pedicle flap adds $2,000 to $5,000. Reconstruction is always billed under separate codes and is not included in the Mohs excision fee.
• Self-pay cash bundles at independent dermatology offices. Many private Mohs surgery practices offer a negotiated cash price to self-pay patients that is 30 to 50 percent below the chargemaster rate, often posted on the practice website or provided over the phone. Ask specifically: 'What is your self-pay cash price for a one-stage Mohs on the face?' before scheduling.
• Hospital chargemaster discount ask. For Mohs procedures performed at a hospital-affiliated center, most hospitals publish a self-pay discount policy of 20 to 60 percent off the chargemaster under CMS price transparency requirements. Some hospitals apply the discount automatically when a patient identifies as uninsured; others require an explicit written request before the procedure date.
• Sliding-scale Federally Qualified Health Centers (FQHCs). A limited number of FQHCs provide dermatology services including basic skin cancer surgery on a sliding-scale fee basis tied to household income and the federal poverty level. Coverage varies widely; not all FQHCs perform Mohs surgery. Contact your local FQHC directly to confirm whether Mohs surgery or excision is available and at what cost scale.
• Prior authorization status. Commercial insurers and some Medicare Advantage plans require prior authorization for Mohs surgery. Failing to obtain authorization before the procedure can result in full denial or significantly higher out-of-pocket cost. Original Medicare does not require prior authorization but Local Coverage Determinations set documentation standards for high-stage Mohs cases.

Common Mohs Surgery Billing Errors

Mohs surgery bills are among the most error-prone in dermatology because the procedure involves multiple separately billable components: the Mohs excision itself (billed per stage and per site complexity), pathology preparation, reconstruction, anesthesia, and the facility fee. Check for these errors before paying any Mohs surgery bill:

• Reconstruction billed as included in the Mohs excision. Wound repair (flap, graft, or intermediate closure) is never included in the Mohs stage codes. If your bill shows only a single line for the Mohs procedure and you had a flap or graft, that is likely a billing error or a bundling issue requiring itemization.
• Anesthesiologist billed out-of-network when the facility is in-network. Mohs surgery typically uses local anesthesia administered by the surgeon, but some hospital-based or ASC cases use monitored anesthesia care from a separate anesthesiologist. The No Surprises Act protects against out-of-network balance billing for emergency and non-emergency services at in-network facilities. Do not pay a balance bill from an out-of-network anesthesiologist without checking your rights at healthcare.gov.
• Stage count discrepancy. Each intraoperative Mohs stage must be documented in the operative note with a separate frozen-section pathology report. If you were told you needed two stages but the bill shows three, request the operative notes and pathology reports to verify.
• Hospital outpatient facility rate billed for a procedure performed in an affiliated independent office. Some dermatology groups are 'provider-based' facilities; when this designation applies, they can bill a hospital facility fee even for office-based services. Ask before scheduling whether the location bills as a hospital outpatient department or as a physician office.
• Pathology fees miscoded or double-billed. Each Mohs stage includes the surgeon's own on-site pathology preparation and interpretation. If a separate outside pathology laboratory also submits a bill for the same specimens, that is a duplicate charge. Request itemized bills from all parties.
• Final bill exceeds the Good Faith Estimate by $400 or more. If you received a written GFE before the procedure and the final bill is $400 or more higher, submit a patient-provider dispute resolution claim at cms.gov/nosurprisesact within 120 days of the bill date. Keep the original GFE document as evidence.

Frequently Asked Questions