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Plastic Surgery Medical Billing Services for Higher Collections

Plastic surgery revenue optimization require accurate coding & surgical billing
expertise. We manage complex cosmetic and reconstructive billing, surgical coding,
global periods, and payer-specific requirements, ensuring full reimbursement for
every covered procedure and eliminating surgical claim denials. As a specialized
plastic surgery billing company, we deliver plastic surgery medical billing services and revenue cycle management for US-based plastic surgery practices, including
cosmetic, reconstructive, and hybrid surgical workflows

Get a Free Plastic Surgery Billing Audit

    Why Plastic Surgery Billing Requires
    Specialized Surgical Intelligence

    Cosmetic and reconstructive claims look similar on paper but pay very differently. One coding slip, missing prior authorization, or weak documentation turns high-value procedures into denials and delays. Our plastic surgery medical billing services align CPT, ICD-10, modifiers, and payer policies to prevent rejections before submission. Avenue Billing Services fixes claim flow, reduces A/R days, and protects revenue for plastic surgery practices.

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      Insurance Coverage Determination

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      Medical necessity support

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      Surgical package compliance

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      59, 78, 79, RT/LT, 62, SG

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      Unbundling Prevention

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      Documentation Validation

    We eliminate these risks using surgery-trained coders, payer-rule automation, operative-note validation, real-time scrubbing, and aggressive A/R and appeals workflows.

    Plastic Surgery RCM & Billing Services Designed for Surgical Accuracy

    Our plastic surgery revenue cycle management services support cosmetic, reconstructive, and hybrid surgical billing workflows from charge capture to final reimbursement

    Plastic Surgery Medical Billing
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      Clean claims for surgical services

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      Modifier logic aligned with procedures

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      Operative documentation validation

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      Out-of-network plastic surgery billing support

    Plastic Surgery Coding Expertise
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      CPT accuracy for grafts and flaps

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      ICD mapping for reconstructive cases

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      Payer guideline compliance

    Cosmetic & Reconstructive Workflows
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      Covered vs non-covered separation

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      Prior authorization preparation

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      Bundling and global-period validation

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      Self-pay cosmetic surgery billing workflows

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      ABN and patient financial responsibility management

    A/R & Surgical Denial Recovery
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      Structured 30/60/90+ follow-up

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      Medical necessity appeal handling

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      Global-period denial correction

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      Cosmetic exclusion appeal review (where applicable)

    Credentialing & Enrollment
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      Medicare and Medicaid setup

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      Commercial payer contracting

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      Hospital privilege coordination

    Compliance & Risk Control
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      CMS and OIG alignment

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      Medical necessity verification

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      Surgical documentation audits

    Surgical Revenue Analytics
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      Procedure-level profitability insights

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      Payer reimbursement tracking

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      Revenue performance dashboards

    Plastic Surgery Procedures & Services We Bill

    We provide procedure-level plastic surgery billing and coding across cosmetic, reconstructive, medically necessary, and hybrid surgical services

    Reconstructive Surgery Billing

    Breast reconstruction (DIEP, TRAM)

    Mohs repairs & layered closures

    Skin grafting (split/full thickness)

    Scar revision & keloid treatments

    Post-mastectomy reconstruction

    Traumatic injury reconstruction

    Facial reconstruction (nose, ear, eyelid, lip)

    Burn reconstruction & complex closures

    Cosmetic Procedure Billing

    Breast augmentation/reduction

    Blepharoplasty (upper/lower eyelid)

    Rhinoplasty (functional/trauma-based)

    Abdominoplasty / panniculectomy

    Liposuction for medical indications

    Functional revision procedures

    Hand & Microsurgery Billing

    Tendon repair

    Nerve repair

    Carpal tunnel release

    Trigger finger surgery

    Fracture repair

    Microsurgical procedures

    Joint reconstruction

    Dermatologic & Lesion Procedures

    Excision of benign/malignant lesions

    Skin biopsy coding

    Complex wound repairs

    Tissue advancement flaps

    Graft + flap documentation verification

    Craniofacial & Pediatric Plastic Surgery

    Cleft lip/palate repair

    Craniosynostosis surgeries

    Congenital deformity reconstruction

    Pediatric trauma repair

    Facial symmetry correction

    Aesthetic Clinic & Office-Based

    Botox for hyperhidrosis

    Dermal fillers with medical indications

    Laser treatments (vascular, pigmentation)

    Chemical peels (medical-grade)

    Acne scar treatments

    How We Handle Plastic Surgery Billing

    Our outsourced plastic surgery billing process is designed to protect medical necessity, prevent denials, and maximize surgical reimbursement

    Detailed operative note review

    ICD–CPT linkage for reconstructive necessity

    Modifier assignment (62, 59, RT/LT, 78/79)

    Prior authorization check for reconstructive cases

    NCCI edit + bundling audit

    Documentation + photo requirement validation

    Payer-specific rule alignment

    Compliance clearance for Medicare/Commercial plans

    Major Billing Challenges in Plastic
    Surgery and Our Fixes

    Cosmetic vs Reconstructive Misclassification

    Fix: Automated global-period tracking + coder review.

    Missing Modifier Requirements

    Every claim is coded, checked, and validated with precision.

    Global Surgical Period Errors

    Every claim is coded, checked, and validated with precision.

    Bundling Denials Under NCCI

    Every claim is coded, checked, and validated with precision.

    Operative Report Coding Discrepancies

    Every claim is coded, checked, and validated with precision.

    Common Plastic Surgery Claim Denials & Fixes

    Below are the most common plastic surgery insurance denial codes resolved across Medicare and commercial payers

    Denial Code

    CO-50

    CO-16

    CO-97

    CO-109

    CO-151

    PR-1

    Issue

    Not medically necessary

    Missing documentation

    Bundled service

    Not covered

    Frequency limit

    Deductible

    Surgical Reason

    Cosmetic misclassification

    Op report/photo missing

    Procedure incorrectly paired

    Cosmetic indication

    Multiple revisions

    Medicare covered services

    Fix

    Add ICD support + documentation

    Attach operative notes

    Apply correct surgical modifiers

    Benefit check + ABN

    Documentation + medical necessity

    Eligibility + patient communication

    EHR/EMR Platforms We
    Support for Plastic Surgery

    Plastic Surgery
    Subspecialties We Support

    Reconstructive Plastic Surgery

    Cosmetic Surgery

    Microsurgery

    Hand Surgery

    Burn Reconstruction

    Craniofacial Surgery

    Pediatric Plastic Surgery

    Oncoplastic Surgery

    Why Plastic Surgeons
    Choose Us

    98% Clean
    Claim Rate

    30–50% fewer
    surgical denials

    Operative note–trained
    coding team

    Real-time surgical
    revenue analytics

    CMS + HIPAA + OIG
    compliant workflows

    Dedicated plastic
    surgery billing team

    States We Serve

    New York

    North Carolina

    Florida

    South Carolina

    Massachusetts

    Alabama

    VIEW ALL

    Separate Cosmetic & Reconstructive
    Billing with Confidence

    Talk with plastic surgery billing experts who manage medical
    necessity, global periods, and surgical documentation.

    MAKE A CALL

    Frequently Asked Questions

    Q1: How does plastic surgery billing differ from other specialties?

    Surgical billing involves global periods, complex modifiers, reconstructive documentation, and payer-specific cosmetic rules.

    Q2: Which plastic surgery procedures do you bill?

    Reconstructive, cosmetic (when covered), craniofacial, hand, burn, and aesthetic medical procedures.

    Q3: Do you code directly from operative reports?

    Yes, certified surgical coders review op notes for accuracy.

    Q4: Do you help with authorization for reconstructive surgery?

    Yes, including photos, clinical notes, and ICD justification.

    Q5: Can you reduce plastic surgery denials?

    Typically 30–50% reduction within 60 days.

    Q6: Do you support multi-location plastic surgery practices?

    Yes, from solo surgeons to large reconstructive groups.

    Q7: Do you handle cosmetic billing where coverage applies?

    Yes, only medically necessary cosmetic procedures with documentation.