Does Medicare cover reconstruction ear surgery after Mohs surgery.

[te1271]

  I may have to have a large portion of the top of my ear removed due to skin cancer. Will Medicare cover reconstruction surgery afterward? I know I'm going to have major issues with missing half my ear. 

[GailL1 · Accepted solution]

As always - as long as it is medically necessary, so, most likely it is covered and is within the scope of the reconstruction and not just cosmetic.  Your surgeon will discuss what they deem will possibly be needed.  They should know all the info that Medicare needs to approve the claim.  

CMS.gov. Medicare Coverage Determination - A57767 - Billing and Coding: Mohs Micrographic Surgery (MMS)

This is mostly written for the doctor (surgeon) or claim submitter for them but it gives some good info about the various types of fixes depending upon how much has to be done to remove the cancer.

Prior approval may be necessary like other type reconstructions.

Medicare.gov - Cosmetic Surgery Coverage

Talk to the surgeon.  

[te1271]

  I Don't know how medically necessary it will be. They will probably have to remove a good portion of the top of my ear. I will still be able to hear but it will look nasty having half an ear on one side. Getting prior approval with Medicare is sometimes difficult.  

[GailL1]

@te1271 

Your doc - the surgeon - or his staff should handle any prior approvals if necessary.

When Medicare or other health insurers say they don’t cover cosmetic surgery - that’s what they are talking about - cosmetic surgery to change something you already have but you want something different - it is a desire, not a medical necessity because the part might work and look just fine to others.

Reconstructive surgery is different since it is building something back that has been changed by an accident or disease.  Now if you wanted “Spock”ears (reference to Star Trek) you know the pointed ones - then that would be more than just reconstruction.  

Talk to the surgeon - I’m sure you probably aren’t the 1st Medicare patient that has had to undergo such surgery and reconstruction. 

[te1271]

Thanks. I had the first Mohs surgery and have to wait 3 weeks to complete the flap reconstruction surgery. I guess I'm going to find out real soon if everything was covered.

[JoyceeO838063]

Did medicare cover?  I also have to have this done.

[te1271]

Yes my Medicare with plan G covered the cost