Cosmetic and reconstructive cases don’t bill the same way. Your team is juggling cash-pay packages, CareCredit, insurance pre-authorization for reconstructive indications, global-period surgery rules, and staged procedures — often on the same patient. We speak that language natively.
Plastic surgery claims live on the edge of three rulebooks: payer medical-necessity policy for reconstructive work, cash-pay and financing workflows for cosmetic work, and surgical global-period rules that govern both. Missing a modifier, a pre-auth, or a global-period follow-up can silently erase thousands of dollars per case.
We staff plastic-surgery-trained coders and billers, not a general pool. Every case gets eyes that know why 15734 needs the right laterality modifier, why a 19318 reduction needs measured photos and symptomatology, and why a post-op visit in the 90-day global still needs to be captured for utilization — even when it doesn’t bill.
Cash, insurance, and hybrid cases — each gets its own lane.
Quote creation, deposit tracking, CareCredit/Alphaeon/PatientFi settlement reconciliation, and clean cash-pay superbills for patients who want to pursue out-of-network reimbursement themselves.
Medical-necessity documentation prep, pre-authorization and peer-to-peer support, CPT/ICD-10 coding, clean claim submission, and appeals when payers push back on breast reduction, panniculectomy, blepharoplasty, rhinoplasty with functional indication, and skin cancer reconstruction.
When a case has both components (e.g., panniculectomy with concurrent abdominoplasty, or reconstructive breast work with cosmetic augmentation), we split the billing correctly, document the non-covered portion, and capture the patient-responsible balance without blowing the insurance claim.
A sample of the procedures we code and bill every week. We’re not learning on your claims.
CPT codes shown for illustration. Actual coding is driven by documentation and medical necessity on a per-case basis.
The difference between a paid reconstructive claim and a denied one is almost always documentation submitted at the right moment, in the right format.
Schnur scale calculations, measured removal grams, photographic documentation, symptom history (cervical/thoracic pain, intertrigo, grooving), trial of conservative therapy, and payer-specific criteria tracking (Aetna, BCBS, UHC, Cigna all differ).
BMI stability documentation, pannus grade, chronic intertrigo or cellulitis history, hygiene limitations, conservative treatment trial, and careful separation from any concurrent cosmetic abdominoplasty work.
Objective obstruction documentation (NOSE score, rhinomanometry when available), failed medical management, CT findings, and correct bundling of 30520 with functional 30400-series coding.
Visual field testing with and without taping, margin reflex distance measurements, photographic documentation, and payer-specific threshold tracking.
Mohs coordination, pathology linkage, proper use of adjacent tissue transfer (14000–14302) vs. complex repair codes, and modifier usage when the reconstruction spans multiple anatomic sites.
WHCRA compliance tracking, staged-procedure coordination, tissue expander to implant exchanges, contralateral symmetry procedures, nipple-areola reconstruction, and 3D tattooing where billable.
Cosmetic cases have their own accounting reality: deposits, staged payments, financing platforms, refundable consult fees, package pricing, and out-of-network superbills that patients submit themselves.
We track every dollar from quote to collection and reconcile financing-platform settlements against your deposit register — so month-end actually closes cleanly.
Clean separation of professional and facility claims, ASC-specific HCPCS (including implants with pass-through eligibility), and coordinated denial work when the two claims touch the same payer.
When a general surgeon and plastic surgeon share a case — mastectomy plus immediate reconstruction is the classic — we coordinate documentation across practices so neither claim gets denied for lack of operative note language.
Correct modifier selection for MD vs. PA/NP assistants, teaching-hospital rules when 82 applies, and denial rework for payers that quietly stopped reimbursing assistants on specific codes.
Not a PDF of undifferentiated aging. A real conversation with a human who knows your practice.
Broken out by cosmetic cash, reconstructive insurance, and hybrid cases.
Percentage of claims paid on first submission, trended monthly.
Against contracted rates, with payer-level breakdowns.
Grouped by CARC/RARC with a closed-loop fix for each recurring pattern.
Average time from submission to approval, by payer and procedure.
Visits that should have billed with modifier 24 / 79 and didn’t.
Deposits, financing settlements, refunds — tied to procedures.
Every provider, every payer, every expiration date visible in one place.
“[Plastic surgery testimonial placeholder — to be replaced with an approved, attributed or anonymized quote from one of the three current plastic surgery clients.]”— Practice Administrator, plastic surgery practice
“[Plastic surgery testimonial placeholder — consider a quote that highlights a reconstructive case approval or cash-pay reconciliation win.]”— Plastic & Reconstructive Surgeon
Most likely, yes. We regularly work inside Nextech, Modernizing Medicine (ModMed), PatientNow, Symplast, AdvancedMD, Kareo/Tebra, Athena, eClinicalWorks, and others. We integrate with your existing system rather than making you change platforms.
Cosmetic cases don’t go to insurance. Revenue comes from patient deposits, financing platforms (CareCredit, Alphaeon, PatientFi, Cherry), and direct payments. We track each dollar against the quoted procedure, reconcile financing settlements, and — for patients with out-of-network benefits who want to pursue reimbursement themselves — prepare a formatted superbill.
Every denial is investigated against the payer’s specific medical-necessity policy. We prepare appeals with the exact documentation that payer requires (Schnur charts, photos, symptom history, failed conservative therapy, etc.), coordinate peer-to-peer reviews with the surgeon, and track the pattern so the next similar case ships with the right paperwork from the start.
We split the billing correctly. The reconstructive portion is submitted to insurance with proper documentation; the cosmetic portion is quoted, deposited, and collected from the patient. The operative note, financial consent, and ABN (where relevant) all need to reflect the split — we build that into the pre-op workflow.
Typically 2–4 weeks. We start with a 30-day billing review at no charge so you can see what we see, then — if we’re the right fit — we move into credentialing review, PM/EHR access, fee schedule loading, and a parallel-run period where we work beside your existing team before cutting over.
Yes. We’re based in New City, NY, with a coordinated team in India. We bill for practices across the United States and are set up for multi-state licensure, payer enrollment, and state-specific Medicaid rules.
Predictable fee structure based on scope. No per-denial fees, no surprise line items. Exact pricing depends on volume, case mix (cosmetic vs. reconstructive split), and scope of services — we’ll quote after the free billing review.
Free plastic-surgery-specific billing review. No obligation, no software change required.