Maximize your plastic surgery practice revenue with specialized billing expertise in cosmetic versus reconstructive coding, medical necessity documentation, and complex modifier management. Our certified coders understand the unique requirements of both insurance-covered reconstructive procedures and patient-pay cosmetic services.
Our coders are trained to navigate the complex cosmetic vs reconstructive distinction, global period management, and multi-procedure modifier strategies that maximize your insurance reimbursements while protecting your patient-pay revenue.
Plastic surgery practices face unique billing complexities with cosmetic versus reconstructive distinctions and complex documentation requirements.
Distinguishing between cosmetic procedures (patient-pay) and reconstructive procedures (insurance-covered) requires precise documentation and coding expertise.
Proving medical necessity for reconstructive procedures requires extensive documentation, clinical photos, and detailed operative reports.
Plastic surgery procedures require complex modifier usage for staged procedures, bilateral surgeries, and multiple procedures performed simultaneously.
Determining which procedures are covered by insurance versus patient-pay requires knowledge of payer policies and coverage criteria.
Reconstructive procedures often require extensive prior authorization with clinical documentation, photos, and supporting medical records.
Billing multiple procedures performed in the same operative session requires expertise in NCCI edits and appropriate use of modifier 51 and 59.
Our plastic surgery billing specialists combine reconstructive coding expertise with medical necessity documentation support.
| Code | Description | Coverage | Billing Notes |
|---|---|---|---|
| 19301 | Mastectomy, partial (lumpectomy) | Insurance | 90-day global. Often billed with sentinel node biopsy (38792) |
| 19380 | Revision of reconstructed breast | Insurance | Requires documentation of functional impairment or symmetry for coverage |
| 14000–14350 | Adjacent tissue transfer/rearrangement | Insurance | Reconstructive — document wound size and complexity. May require prior auth |
| 21120–21127 | Genioplasty (chin surgery) | Varies | Cosmetic if aesthetic only; insurance if for functional/trauma reasons |
| 30400–30462 | Rhinoplasty | Varies | Cosmetic if aesthetic; insurance if post-traumatic or functional. Document carefully |
| 15734 | Muscle, myocutaneous flap, trunk | Insurance | Reconstructive procedure. Document defect size and reconstruction rationale |
| 11970 | Replacement of tissue expander with permanent implant | Insurance | Staged procedure modifier 58. Document initial expander placement date |
CPT codes for reference only. Coverage varies significantly by payer and medical necessity documentation.
Get a free billing audit and discover how our reconstructive surgery billing specialists can recover revenue from denied and underpaid claims.