Cosmetic denials
Reconstructive procedures denied as cosmetic. Medical necessity documented and appealed.
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Plastic Surgery medical billing services
Plastic surgery billing separates reconstructive from cosmetic work and documents medical necessity for everything reconstructive: breast reconstruction, skin cancer repair, hand surgery, trauma. Where insurance pays, the rules on staged procedures, flaps and grafts are specific; where it does not, self-pay workflows must be clean.
What makes plastic surgery billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether plastic surgery claims pay the first time.
- Reconstructive procedures need medical-necessity documentation; payers presume cosmetic intent unless the record shows otherwise.
- Flaps, grafts and complex repairs are coded by size, site and technique with specific measurement requirements.
- Breast reconstruction after mastectomy is covered by federal law (WHCRA), but staged procedures and symmetry work still require authorization.
- Cosmetic procedures are self-pay and must not be billed to insurance; mixed cases require careful separation.
Denials we see most in plastic surgery
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Measurement and technique errors
Repairs and grafts reduced for undocumented size. Billed from measured documentation.
Staged procedure authorization
Later stages denied for missing authorization. Tracked per treatment plan.
How Core MB bills for plastic surgery
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new plastic surgery providers runs in the same system, tracked live in your client portal.
- Medical-necessity documentation and appeals for reconstructive work.
- Repair, flap and graft coding from measured documentation.
- Authorization tracking across staged procedures.
Everything in the service
The full revenue cycle as standard for plastic surgery practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Plastic Surgery billing questions
How do you get reconstructive procedures paid?
By documenting medical necessity explicitly and coding from measured, specific operative reports. Payers presume cosmetic intent, so the record has to prove otherwise.
Is breast reconstruction always covered?
Post-mastectomy reconstruction is covered by federal law, but each stage and symmetry procedure may still need authorization. We track them.
Can you keep cosmetic and insured work separate?
Yes. Cosmetic services are self-pay and never billed to insurance; we maintain the separation in mixed cases.
How do we get started with Core MB for plastic surgery billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new plastic surgery providers can start at the same time.
More in surgical and procedural
Find out what your plastic surgery billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.