Specialized billing for plastic surgeons — reconstructive vs cosmetic billing, insurance authorization, and plastic surgery RCM. Serving practices nationwide across the United States.
Get Free Practice Audit Contact UsComprehensive billing coverage for your specialty
Expertly separating medically necessary reconstructive procedures from cosmetic ones, with proper documentation to support insurance claims.
Billing for burn treatment, skin grafts, wound debridement, and complex wound care with accurate size and complexity coding.
Post-mastectomy breast reconstruction billing including implant codes, flap procedures, and WHCRA compliance.
Obtaining prior authorization for reconstructive procedures with supporting clinical documentation and photos.
Professional cosmetic procedure invoicing, payment plan management, and financing coordination for aesthetic procedures.
Monthly reports separating insurance vs cash pay revenue with procedure-level profitability analysis.
No specialty lives on the line between covered and non-covered care the way plastic surgery does. The same CPT code can be a paid reconstructive claim for one patient and a cash cosmetic procedure for the next — and the payer's decision rides entirely on documentation, prior authorization, and how the claim is built. A plastic surgery billing company has to run two revenue systems in parallel: an insurance operation for reconstructive work and a self-pay operation for cosmetic work, without ever letting the two contaminate each other. That is exactly how we run plastic surgery medical billing for our clients.
Insurance pays for procedures that restore function or correct deformity from trauma, disease, or congenital conditions — and refuses procedures performed for appearance. Breast reconstruction after mastectomy is covered by federal law (WHCRA); breast augmentation is not. Panniculectomy after massive weight loss can be covered with documented rashes and functional impairment; abdominoplasty for contour is cash. Our billers build every insurance claim around the functional indication, with the diagnosis codes, photos, and clinical history that prove it — because a reconstructive claim that reads like a cosmetic one is a guaranteed denial.
Almost every payable plastic surgery procedure needs prior authorization, and plastic surgery auths are unusually demanding: standardized photographs, conservative treatment history, measurements (gram estimates for reduction mammaplasty, visual field studies for blepharoplasty), and symptom documentation over time. We manage the entire auth package — assembling requirements payer by payer before the case is scheduled — because a missing photo series discovered the week of surgery is a cancelled case or an unpaid one.
A handful of procedures generate most plastic surgery denials. Reduction mammaplasty requires documented symptomatic macromastia — neck and back pain, shoulder grooving, intertrigo — plus payer-specific tissue-weight thresholds, and denials are worth appealing because criteria are objective. Functional blepharoplasty needs visual field testing showing obstruction. Panniculectomy needs weight stability and documented skin conditions. Rhinoplasty is covered only with a functional airway component, coded and documented separately from any cosmetic work. We know each payer's criteria and build the claim to meet them the first time.
Plastic surgery's hardest billing scenario is the combined case — a functional septoplasty with cosmetic rhinoplasty, or a covered breast reduction with a cosmetic contralateral procedure. The covered portion bills insurance with precise operative-note allocation; the cosmetic portion is quoted and collected as self-pay; shared costs like anesthesia and facility time must be split defensibly. Done wrong, this is where practices commit accidental insurance fraud or leave thousands uncollected. We structure hybrid cases with clean cost allocation that survives both payer audits and patient disputes.
Major reconstructive procedures carry 90-day global periods, and plastic surgery is full of staged work — tissue expander to implant exchange, flap revisions, nipple reconstruction. Staged and related procedures during a global period need modifier 58; complications requiring a return to the OR need modifier 78; unrelated new procedures need 79. Misused global-period modifiers are one of the top revenue leaks in reconstructive practices, and one of the first things we audit for new clients.
Full revenue cycle management built for plastic surgery: insurance verification and prior authorization with photo package management, reconstructive claim coding and submission, medical-necessity appeals with payer-criteria documentation, hybrid case cost allocation, self-pay and financing workflow support, and monthly reporting that separates your insurance and cosmetic revenue streams. Read our complete plastic surgery billing guide for the full playbook, or get a free one-week audit of your recent claims.
Specialties that share the reconstructive-versus-cosmetic determination and its authorization burden.
Mohs reconstruction and the cosmetic-versus-medical line are shared daily determinations.
Facial reconstruction spans both specialties, splitting functional from cosmetic components.
Post-mastectomy reconstruction is medically necessary and protected by federal law, not a cosmetic claim.
The anesthesia claim has to carry the same medical-necessity documentation as the surgical claim.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Get a free billing audit and maximize both your insurance and cash pay revenue.
Get Free Practice AuditFree resources: Denial Code Lookup | RVU Calculator | AR Days Calculator | CO-50 — medical necessity (cosmetic vs reconstructive)
Read our guide: Plastic Surgery Billing: Complete Guide for 2026