CMS Excision of Malignant Skin Lesions Form

Summary Of Evidence

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Analysis of Evidence

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History/Background and/or General Information

A skin lesion is any alteration in the normal skin architecture. Lesions can be benign, pre-malignant or malignant. The most common malignant lesions are Basal Cell Carcinomas (BCC), Squamous Cell Carcinomas (SCC) and Melanomas.

Four of the most common methods of treatment of malignant skin lesions are:

• Surgical excision,
• Electrodesiccation (tissue destruction by heat),
• Radiation therapy, or
• Cryosurgery (tissue destruction by freezing)

Covered Indications

The treatment of choice for malignant skin lesions is complete excision that includes a variable margin of surrounding tissue in order to eradicate microscopic tumor cells, which may have spread beyond the visible borders of the lesion.

The excision of a malignant skin lesion including margins will be considered medically necessary when a pathology report verifies the existence of a malignancy.

Limitations

As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.