SpecialtiesSurgical
How we see plastic surgery billing.
Reviewed by the VisMed surgical billing team
Insurers pay for reconstruction and functional procedures and do not pay for cosmetic ones, and the line is drawn by documentation: photographs, measurements, symptoms, failed conservative treatment. The same operation can be covered or not depending on what the note shows. Practices that document loosely lose covered procedures to denials and expose themselves to audits when cosmetic work touches a claim.
The covered work has its own complexity: breast reconstruction with federally protected coverage and staged procedures, flaps and grafts coded by type and area, hand surgery with global-period and therapy rules, and skin cancer reconstruction after Mohs with size and repair coding.
VisMed runs plastic surgery with a hard separation between insurance and self-pay workflows, authorization built on the plan’s medical-necessity criteria with photos and measurements, and coders who work flap, graft and repair coding daily.
Where plastic surgery practices lose money
The patterns we find in the aging and denial history before anything else changes.
Covered procedures denied as cosmetic
Reduction mammaplasty, panniculectomy, blepharoplasty and septorhinoplasty are covered when criteria are met and documented. Notes without measurements, photos and symptoms lose them.Staged reconstruction modifiers
Planned stages take modifier 58; revisions and complication returns take other modifiers. Wrong modifiers inside the global deny or reduce.Flap and graft coding
Codes step by type, area and site. Under-measured or generically described repairs bill a step low.Cosmetic and covered on the same day
When both happen in one session, the covered portion must be documented and billed on its own, with the cosmetic portion charged to the patient. Blurred lines lose the covered part or create compliance risk.Authorization drift
The procedure performed differs from the approval, in extent or in codes, and the claim is denied.
What we do differently for plastic surgery
Specialty-matched coders and a denials specialist, working inside your own system.
We keep two workflows in one practice
Insurance and self-pay cases are separated at scheduling, with cosmetic charges handled in your system outside any claim.We authorize on the plan’s criteria
Photos, measurements, symptom history and conservative treatment are assembled to the plan’s policy before the request.Our reconstruction coders work from the report
Flaps, grafts, repairs and staged procedures are coded from the operative report with global-period modifiers applied per case.We match the approval at charge entry
The operative report is compared with the authorization and we seek amended approvals before submission when they differ.
What we bill
The procedure and code families your account team already works in.
Plastic surgery billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed get procedures like breast reduction approved?
By assembling exactly what the plan’s medical policy asks for: measurements, estimated tissue weight where used, photographs, documented symptoms and conservative treatment. VisMed sends the request complete and matches the approval to the scheduled procedure.
How does VisMed keep cosmetic work off insurance claims?
With a separate self-pay workflow from scheduling onward. Cosmetic charges never touch a claim, and when covered and cosmetic work happen in one session, VisMed documents and bills the covered portion on its own.
Does VisMed handle staged reconstruction billing?
VisMed bills planned stages with modifier 58 inside the global, and revisions and complications with the modifiers their circumstances require, all tracked per case.
Can VisMed bill reconstruction after Mohs performed by another practice?
VisMed codes repairs, flaps and grafts by size, type and site from your operative note, and coordinates with the Mohs practice so the two claims do not conflict.
Does VisMed handle breast reconstruction coverage rules?
Yes. Reconstruction after mastectomy, including symmetry procedures on the other breast and prosthesis-related care, has federally protected coverage that plans still apply inconsistently. VisMed cites the coverage requirement in the authorization and the appeal when a plan treats a stage as cosmetic.
Also in surgical
General surgery
Global-period tracking and assistant-at-surgery claims.
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Thoracic surgery
Complex globals and critical-care overlap.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
OB/GYN
Global obstetric packages and gyn procedures.
Ambulatory surgery centers
Facility claims, implants and payer-specific groupers.
Anesthesia
Time units, modifiers and medical direction.
All specialties
The full list, in six groups
See where your plastic surgery practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med