WHICH PLASTIC SURGERY PROCEDURES ACTUALLY PAY (THROUGH INSURANCE)?

September 9, 2022
by Admin

WHICH PLASTIC SURGERY PROCEDURES ACTUALLY PAY (THROUGH INSURANCE)?

As a plastic surgeon, it’s likely that you got into this field because you like to help people. 

But, realistically, you can’t help every person that walks through your doors and still keep the lights on. To run a successful practice, you have to keep an eye on not only your moral mission, but the bottom line, which means looking at which insurance-billed procedures bring you the highest reimbursement.

A doctor that sometimes turns a case down is a lot better than a doctor that says yes all the time, but can’t actually support the growth of their practice. It’s all about leveraging the plastic surgery procedures that actually pay the most.

Which brings us to our phrase of the day: “Optimize your time.” 

One of the best ways to optimize your time and energy is to weed out the plastics procedures that do not best serve you.

Focus not on taking in as many patients as possible, but on taking the cases that most effectively get you the highest reimbursement for your time.

But, we’re not just seeing green here. It’s not quite as simple as just taking the quickest, most expensive procedures, and kicking the rest to the curb.

Factors like what you specialize in, the demand in your area at any given time, and other benefits like building and maintaining relationships with your patients also play a role in deciding which procedures are and are not worth your time.

Your time is valuable both in the OR and while chasing down insurance companies. So, while some procedures may seem valuable on paper, they may not pan out quite as well in reality when accounting for the time and energy to make sure you actually get your money.

But, I wouldn’t waste my time and yours by just explaining the issue and not resolving it. Let’s break down some procedures into what is definitely worth your time, maybe worth your time, and probably not.

Which plastic surgery procedures actually pay and are worth your time?

Plastic Surgery Procedures That DEFINITELY Pay:

  • Lumps/Bumps
    • Reimbursement: ~$500-700
    • Although the cost of these procedures varies greatly depending on closure type, size, and location, they’re incredibly quick to execute. Knocking out a procedure in 15 min, you could easily make $2-2.8K for just an hour of your time.
  • Microsurgery
    • Reimbursement: ~$4K
    • While this cost alone is solid, you could nab a co-surgeon and get through these procedures even quicker. This could easily make you $1K/hr and DIEP flaps can fetch $10K+ per side depending on payer and coding.
  • Breast Reconstruction
    • Reimbursement: $2K+
    • Depending on the type of reconstruction, these procedures can take anywhere from 1-6 hours and the cost can vary greatly as well. 
  • Hand Reconstruction
    • Reimbursement: variable
    • With these procedures, “unbundling” is allowed, meaning you can bill separately for each structure’s repair above board. Therefore, you get more bang for your buck over time. There’s wide variability, but cases can get into 5 figures very quickly.

Plastic Surgery Procedures That MAYBE Pay:

  • Blepharoplasty
    • Reimbursement: ~$1.2K (bilateral) 
    • You can bill OOP for the ptosis or, even better, do the reverse and bill the ptosis through insurance (it pays about 15% more) and charge cosmetically for the blepharoplasty.
  • Craniomaxillofacial (CMF)
    • Reimbursement: ~$1K+ 
    • These procedures are complex and time-consuming, and just over a grand is likely not enough to make these procedures particularly profitable.
  • Scar Revision
    • Reimbursement: ~$500
    • For these, think Lumps & Bumps with scrutinized medical necessity. Maybe not worth the quick buck if it ain’t so quick to get (because you have to appeal 2x and send records).

Plastic Surgery Procedures That PROBABLY DO NOT Pay:

  • Panniculectomy
    • Reimbursement: ~$1.2K 
    • This one simply may not be worth the hassle. We do not recommend layering myo flaps to augment reimbursement, but lipectomy of the hip may be applicable and may double your reimbursement.
  • Breast Reduction
    • Reimbursement: ~$1.8K 
    • With procedures taking anywhere from 2-3 hours, you’re only set to make about $600/hr, which is less than Roto Rooter makes for plumbing and water cleanup.
  • Nasal Septum Reconstruction (NSR)
    • Reimbursement: ~$700-1.5K
    • With patients pushing you to do a rhino for free as an added bonus, this is the exact opposite of what we’re talking about here.
  • Debridement (Wound Care)
    • Reimbursement: ~$130/20cm²
    • Need I say more?
  • Therapeutic Botox
    • Reimbursement: Dismal
    • Botox is a pain to get paid and you’ll likely make a net even. Now, take a look at SPG/LON/GON nerve block treatment series pre-Botox and you’ve got a $6K care regimen that requires the MD on 3/12 visits for all of 45 minutes total. This can be a great ROI.

Now, of course, if you only take the “DEFINITELY YES” category cases every single time, you’re not likely to develop a consistent client-base and your reputation as a plastic surgeon could tank.

The key is to take on what you love to do, where you want to give back, and where you’re paid well. 

Figuring out the right balance for your plastic surgery practice takes a lot of time and energy (which we are clearly working on here), so it may be best to outsource.

Our team at the Auctus Group can help you with billing optimization to ensure you’re getting the best bang for your buck across the board. Give us a call to get started.

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