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Plastic Surgery billing

Plastic & Reconstructive Surgery Billing

The line between reconstructive and cosmetic surgery decides who pays. Specialist billers secure authorizations for covered procedures and keep cosmetic revenue clean.

  • Medical-necessity documentation for reconstructive procedures
  • Flap, graft and tissue transfer coding by size and site
  • Clear separation of cosmetic self-pay and insurance claims

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95%
Clean-claim rate target
35%
Fewer authorization denials
< 40
Days in A/R goal
Overview

Reconstructive vs. cosmetic billing

Insurance covers plastic surgery when it restores function or corrects deformity from trauma, disease or congenital conditions, not when it only improves appearance. Procedures like blepharoplasty, breast reduction and rhinoplasty can be covered or cosmetic depending on documentation such as visual field tests, symptoms, photographs and conservative treatment history.

Reconstructive coding is detailed. Adjacent tissue transfers, flaps and skin grafts are coded by size and anatomic site, breast reconstruction follows staged procedures, and Mohs or trauma repairs require coordination with other surgeons. Breast reconstruction after mastectomy is protected by federal law, but still needs correct coding and authorization.

A plastic surgery billing partner assembles medical-necessity packets, files prior authorizations, codes complex reconstructions from operative notes and manages cosmetic financing and deposits separately so your practice’s finances stay clean and compliant.

Why it's hard

Common plastic surgery billing challenges

01

Proving medical necessity

Payers require photos, measurements and symptom documentation for functional procedures.

02

Prior authorization

Most reconstructive procedures need approval before surgery is scheduled.

03

Flap and graft coding

Codes depend on defect size, recipient site and tissue type.

04

Staged reconstruction

Multi-stage breast and trauma reconstructions require modifiers and global tracking.

05

Mixed cosmetic and covered cases

Combining procedures requires splitting covered and self-pay portions correctly.

06

Patient financing and deposits

Cosmetic payments must be handled separately from insurance claims.

What's included

What a plastic surgery billing partner should handle

  • Medical-necessity packet preparation
  • Prior authorization and peer-to-peer support
  • Reconstructive and flap/graft coding
  • Breast reconstruction billing (WHCRA cases)
  • Global period and staged-procedure tracking
  • Cosmetic quotes, deposits and financing support
  • Assistant surgeon and co-surgeon billing
  • Denial management and appeals
  • Patient estimates for combined cases
  • Procedure profitability reporting
Coding focus

Key codes in plastic surgery billing

Code(s)What it covers
15823Blepharoplasty, upper eyelid, with excessive skin weighting down lid (functional).
19318Breast reduction.
19357Breast reconstruction with tissue expander(s), including subsequent expansion(s).
14000–14350Adjacent tissue transfer or rearrangement by site and defect size.
15271–15278Application of skin substitute grafts by site and size.
15734Muscle, myocutaneous or fasciocutaneous flap, trunk.
30400–30462Rhinoplasty procedures (often cosmetic unless functional criteria are met).

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Breast reconstruction rights

The Women’s Health and Cancer Rights Act requires most group health plans that cover mastectomy to also cover reconstruction, including procedures on the other breast for symmetry. Billing should reference this when authorizations are challenged.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven plastic surgery experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their plastic surgery experience.

See all companies
5.0 5 reviews

Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
No reviews yet

GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
Pricing

How much does plastic surgery billing cost?

Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.

Percentage of collections
5% - 9%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Plastic Surgery billing FAQs

When the procedure is reconstructive, restoring function or correcting deformity from injury, disease or congenital conditions, and documentation meets the payer’s criteria.

Upper eyelid blepharoplasty can be covered when visual field testing and photographs show the eyelid obstructs vision.

Often, when documented symptoms such as back and neck pain persist despite conservative treatment and tissue removal meets payer requirements.

By technique, recipient site and size of the defect, using specific CPT code ranges for grafts, substitutes and flaps.

Yes, cosmetic cases are quoted and collected separately from insurance claims, often with financing options.

Typically 5% to 9% of insurance collections.

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