Expert Plastic Surgery Billing for Cosmetic and Reconstructive Care

Cosmetic procedures are typically not covered by insurance and require patient payment upfront. Reconstructive procedures, however, may be medically necessary and billable to insurance using specific ICD-10 and CPT codes. We apply proper documentation and coding to ensure each procedure is billed appropriately based on its clinical justification.

Elective cosmetic procedures are not usually covered by insurance. However, if a procedure has medical necessity, such as breast reconstruction after mastectomy or nasal surgery due to trauma, it can be billed to insurance. Our team ensures accurate documentation and code selection to distinguish between self-pay and insurance-covered services.

Common modifiers include 22 (increased procedural service), 62 (two surgeons), and 76 (repeat procedure). These help explain surgical complexity or special circumstances to payers. Incorrect or missing modifiers are a leading cause of denials. We ensure they’re applied properly every time.

Yes. We handle all aspects of pre-authorization, including gathering clinical documentation, submitting requests, and tracking approvals. This is especially important for reconstructive procedures that require payer approval before surgery.

We track global periods for each surgical procedure to avoid duplicate billing. Our team ensures that all follow-up visits, staged surgeries, or complications are coded correctly and billed within payer guidelines.

Yes. For multi-phase procedures like breast reconstruction or tissue expansion, we use the correct codes and modifiers to reflect each stage and ensure accurate reimbursement.

Denial prevention starts with accurate coding, modifier use, medical necessity documentation, and eligibility checks. We proactively scrub claims and resolve issues before submission, resulting in a 98.9% clean claim rate.

We specialize in billing for procedures such as abdominoplasty, rhinoplasty, blepharoplasty, breast augmentation and reconstruction, liposuction, scar revision, and skin grafts. Each procedure has unique billing requirements, and we handle them with precision.

Yes. For out-of-network providers, we handle UCR (Usual, Customary, and Reasonable) charge calculations, patient collections, and appeals to help you maximize revenue.

Our certified coders specialize in plastic and reconstructive procedures. We understand the documentation, coding, and payer requirements unique to this specialty, resulting in better collections and fewer denials.

Yes. We work directly within your existing systems, including platforms like Nextech, Modernizing Medicine, and DrChrono. This allows for a seamless workflow with no disruptions to your staff.

Yes. We provide weekly and monthly reports with insights on claim status, denial trends, collections, and AR aging, giving you full visibility into your revenue cycle.

Yes. We begin with a free billing performance review. This includes an analysis of recent claims, denial trends, and reimbursement timelines to identify areas of improvement before onboarding.