Plastic Surgery Medical Billing Services
Plastic surgery billing hinges on clearly distinguishing medically necessary reconstructive procedures from cosmetic ones, since only the former is billable to insurance. Flint RCM's plastic surgery accounts are staffed by coders fluent in this distinction.
Specialty-specific pitfalls we watch for.
- Medically-necessary-vs-cosmetic classification disputes that determine whether a procedure is billable at all
- Prior authorization requirements for reconstructive procedures not confirmed before scheduling
- Modifier -22 (increased procedural services) used without documentation supporting the added complexity
- Multiple-procedure modifier disputes on combined reconstructive cases
- Post-mastectomy reconstruction billing coded incorrectly relative to federal coverage mandates
- Medical necessity documentation reviewed and confirmed before classifying a procedure as billable to insurance
- Authorization confirmed before scheduling reconstructive procedures
- Modifier -22 use reviewed against documentation of genuinely increased complexity
- Post-mastectomy reconstruction billing checked against applicable coverage mandates
What makes Plastic Surgery coding different.
- CPT codes selected based on the documented medically necessary indication, not the cosmetic-equivalent procedure name
- Modifier -22 applied only with documentation clearly supporting substantially increased physician work
- Reconstructive procedure staging coded with modifier -58 where a planned multi-stage approach is documented
What to confirm before the visit.
- Medical necessity and prior authorization confirmed before scheduling any reconstructive procedure
- Post-mastectomy reconstruction coverage confirmed against applicable federal and state mandates
Medical-necessity classification disputes are the top reason reconstructive claims get denied outright — AR follow-up appeals with documentation distinguishing the procedure from its cosmetic equivalent.
Our workflow for plastic surgery billing.
Documentation Review
Clinical notes are reviewed to confirm and document the medically necessary indication.
Coding & Modifier Check
CPT and modifier -22 use are checked against documented complexity and indication.
Prior Auth Confirmation
Authorization for reconstructive procedures is confirmed before scheduling.
AR Follow-Up
Medical-necessity denials are appealed with documentation distinguishing reconstructive from cosmetic intent.
What shapes plastic surgery reimbursement.
Payers apply their own medical policies defining what counts as reconstructive vs. cosmetic for the same procedure name — documentation is prepared against the specific payer's policy criteria.
Plastic Surgery billing, answered.
Do you bill for both reconstructive and cosmetic procedures?
We bill medically necessary reconstructive procedures to insurance; cosmetic procedures are handled as self-pay per your practice's policy.
How do you support medical necessity for reconstruction?
Documentation is reviewed and, where needed, supplemented to clearly show the medically necessary indication before submission.
Explore more specialty billing pages.
Get a free plastic surgery billing audit.
We'll review your current claims, denials, and AR to show exactly where plastic surgery revenue is being missed.