Endovenous vein ablation (36475 RF, 36478 laser) is covered for documented saphenous reflux after a failed compression trial — not for spider veins or appearance.

Breast reduction (CPT 19318) coverage isn’t only the Schnur gram threshold — two documented symptoms can qualify it, and prior auth decides whether it pays.

Functional blepharoplasty (CPT 15823) is covered only when excess eyelid skin blocks vision — and the visual field test, not the photo, is what proves it.

Lipedema liposuction (CPT 15877-15879) uses the same codes as cosmetic lipo, so payers deny by default. The documentation that actually gets it covered.

Therapeutic Botox (J0585 + 64615) is covered for chronic migraine and more — but the unit count, JW/JZ wastage, and failed-preventive gate decide the claim.

Benign lesion removal (CPT 17110, 11400-11446) is covered only when symptomatic — and the ICD-10 diagnosis, not the procedure, decides whether it pays.

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.

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.

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.