We stay up to date on the ever-changing insurance market's impacts on your specialty for you...because it's basically a full time job in and of itself.
Septoplasty (30520) is covered for functional nasal obstruction, not for a deviated septum on its own. The line is documented obstruction plus failed medical therapy.
Panniculectomy (15830) is covered when the panniculus impairs function. Abdominoplasty is cosmetic. The add-on +15847 is the line where covered claims turn into denials.
CPT 11102, 11104, and 11106 are biopsy primaries by technique. Use multiple techniques in one visit and you still report one primary plus add-ons, not two primaries.
One in five medically necessary breast reductions gets denied, and the number doing the denying is the Schnur scale. Here’s how each payer sets the bar.
CPT 17110 covers up to 14 benign lesions in one unit, not one per lesion. Bill it per lesion and the payer strips the overage before it pays.
Running plastic surgery billing in-house isn’t one hire — it’s a full revenue-cycle system. Here’s the whole machine, end to end.
In-house or outsourced plastic surgery billing — the real trade isn’t cost. It’s who owns your AR, your follow-up, and your denials.
Outsourced or in-house billing for your dermatology practice? The real cost, where revenue leaks, and five questions to answer before you switch.
On January 1, 2026, Medicare cut skin substitute pay ~90% to a flat $127.14/cm². What survives for plastic surgery and dermatology — and what doesn’t.
The Core Problem: One Code, Many Techniques The technique changes depending on the patient. The CPT code doesn’t. For top surgery — augmentation, reduction, mastectomy with nipple reconstruction — reimbursement is tied to the standard diagnosis for that procedure type. A reduction for macromasty and a reduction for masculinization carry the same code, same reimbursement, […]
