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Blogs

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.

July 7, 2026
by John Gwin

Why Lipedema Surgery Gets Denied as Cosmetic

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

July 4, 2026
by John Gwin

Therapeutic Botox Pays — If the J0585 Units and Wastage Are Right

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.

July 1, 2026
by John Gwin

A Benign Lesion Removal Pays on the Diagnosis, Not the Procedure

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

June 29, 2026
by John Gwin

A Deviated Septum Doesn’t Get Paid. Documented Obstruction Does.

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.

June 27, 2026
by John Gwin

Panniculectomy Pays. Abdominoplasty Doesn’t.

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.

June 24, 2026
by John Gwin

Multiple Biopsy Techniques, One Primary Code. Most Practices Bill Two.

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.

June 22, 2026
by John Gwin

Your Breast Reduction Denial Is a Schnur Problem

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.

June 18, 2026
by John Gwin

17110 Is Not a Per-Lesion Code. Most Practices Bill It Like One.

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.

June 10, 2026
by John Gwin

In-House Plastic Surgery Billing Is a System, Not a Hire

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.

June 10, 2026
by John Gwin

In-House vs Outsourced Plastic Surgery Billing

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.

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