Confirming coverage and a payer’s reconstructive criteria before the case is scheduled, not after the claim is denied.
Plastic Surgery Medical Billing Services
Billing Support for Plastic & Reconstructive Surgeons
From breast reconstruction and panniculectomy to rhinoplasty, blepharoplasty, flap reconstruction, and scar revision, coded and billed by a team trained in the difference.
HIPAA compliant
Certified billing and coding professionals
Nationwide service
🔒 100% confidential. We never sell your data. Privacy Policy
How Thrive Helps
What Thrive Does for Plastic Surgery Practices
Thrive handles the coding and claims work that plastic and reconstructive surgery practices cannot hand to a generalist biller. That starts before the operating room is booked, verifying whether a procedure meets a payer’s reconstructive criteria and securing prior authorization on record. It continues through coding that pairs the correct CPT and ICD-10 combination to the medical necessity documentation already in the chart, submission within 48 hours, and follow-up on anything a payer questions.
When a claim comes back marked not medically necessary, our team builds the appeal instead of writing the balance off. Cosmetic charges are billed to the patient directly. Reconstructive charges go to the payer. Nothing gets mixed together on the same claim.
HIPAA Compliant
AAPC-Certified Coders
Nationwide Coverage
Clean claims on the first submission, not the third.
Coded and submitted claims out the door within 48 hours.
Accounts receivable held under 30 days on average.
A 30% average increase in collected revenue after onboarding.
Plastic Surgery Billing And Coding Services
End-to-End Revenue Cycle Management for Plastic Surgery
Every task below is handled with plastic and reconstructive surgery in mind, not adapted from a generic billing checklist.
Eligibility & Benefits Verification
Prior Authorization
Securing authorization for breast reconstruction, panniculectomy, and other reconstructive procedures ahead of the operative date.
Medical Necessity Documentation & Coding
Pairing CPT and ICD-10 codes to the visual field results, photos, and functional notes a payer’s policy actually requires.
Claims Submission
Clean claims filed within 48 hours of the encounter closing, with modifiers checked before they leave the building.
Denial Management & Appeals
Appealing not medically necessary and bundling denials with payer-specific evidence, not a form letter.
AR Follow-Up
Tracking every open claim, including staged procedures still inside a global period.
Patient Billing & Collections
Clear, separate statements for the cosmetic portion of a case that a patient owes directly.
Payment Posting & Reconciliation
Matching payments against contracted rates so underpayments on reconstructive claims do not go unnoticed.
Credentialing & Enrollment
Getting providers enrolled with payers without delaying their first billable case.
Reporting
Practice-level visibility into clean claim rate, AR days, and denial reasons broken out by procedure.
Plastic Surgery Billing Codes
CPT Codes for Plastic Surgery
A working reference to the CPT and HCPCS ranges most plastic and reconstructive surgery claims are built on. Exact reimbursement depends on documentation, payer policy, and modifier use.
- 14000–14302
Adjacent Tissue Transfer
Local flap repair used to close skin defects from trauma, tumor excision, or prior surgery.
- 15002–15278
Skin Grafts & Wound Prep
Site preparation and grafting for burns, trauma wounds, and reconstructive defects.
- 15820–15823
Blepharoplasty
Eyelid skin and fat removal, coverage tied to documented visual field impairment.
- 67901–67909
Ptosis & Brow Repair
Repair of eyelid drooping affecting the superior visual axis.
- 15830–15839
Panniculectomy
Removal of excess abdominal skin and tissue for documented rashes, infection, or functional impairment.
- 15847
Abdominoplasty (Add-On)
Reported with 15830 for muscle and fascia repair, largely a patient-pay cosmetic component.
- 15877
Suction-Assisted Lipectomy
Fat removal by suction, rarely covered outside select post-bariatric cases.
- 19316–19318
Mastopexy & Reduction Mammaplasty
Breast lift and reduction, with reduction coverage tied to documented symptomatic macromastia.
- 19325
Augmentation Mammoplasty
Implant placement, with coverage differing sharply between cosmetic and post-mastectomy use.
- 19340–19396
Breast Reconstruction
Tissue expander placement, flap reconstruction, and revision procedures following mastectomy.
- 30400–30462
Rhinoplasty
Nasal reshaping, with coverage depending on whether the work addresses a breathing function.
- 30520
Septoplasty
Correction of a deviated septum, coded and billed separately from any concurrent rhinoplasty.
- 21120–21296
Craniofacial & Maxillofacial Reconstruction
Bone and soft tissue reconstruction of the face and jaw.
What Is a Global Surgical Period?
Most plastic surgery procedures carry a 10 or 90 day global period during which routine follow-up care is already paid for inside the original claim. A second procedure performed during that window has to be billed with the correct modifier, 58, 78, or 79, or it gets bundled into the first claim and paid nothing. Breast reconstruction, staged flap work, and revision surgery run through this window constantly, which is why global period tracking is a coding function and not an afterthought.
Where Claims Break Down
Common Plastic Surgery Billing Challenges
The denial patterns below are specific to how payers treat plastic and reconstructive surgery differently from most other specialties.
Cosmetic Reclassification
A payer’s own reviewer decides a reconstructive procedure reads as cosmetic on paper, even when the surgeon’s intent was functional. Documentation gaps, not coding errors, are usually the reason.
Incomplete Medical Necessity Records
Claims for panniculectomy, blepharoplasty, and reduction mammaplasty are denied when the chart is missing the specific proof a payer’s policy requires, such as visual field results or documented skin irritation.
Global Period Modifier Errors
A staged second procedure gets bundled into the first claim’s global period and paid at zero when modifier 58, 78, or 79 is missing or applied to the wrong scenario.
Bundling on Combined Procedures
Panniculectomy performed with abdominoplasty, or multiple flap procedures in one operative session, can be bundled into a single payment unless a distinct procedural service modifier is supported by the operative note.
Prior Authorization Delays
Reconstructive procedures face closer review than most surgical specialties. A missing authorization on the day of surgery turns an approved case into a denied claim.
Bilateral & Multiple Procedure Errors
Bilateral breast procedures billed on the wrong line, or without modifier 50 and correct laterality, are underpaid even when the procedure itself was covered.
Mixed Cosmetic and Reconstructive Sessions
A single operative session that includes both a covered reconstructive procedure and a patient-pay cosmetic add-on has to be split correctly, or the entire claim gets flagged for review.
Co-Surgeon Documentation Gaps
Breast reconstruction performed jointly with a general surgeon after mastectomy requires modifier 62 and operative notes that clearly separate each surgeon’s distinct work.
How We Solve It
The Thrive Process for Plastic Surgery Claims
Every claim moves through the same six steps, each one built to close a specific gap payers use to deny reconstructive procedures.
Verify Eligibility and Authorization Before Surgery Is Scheduled
Coverage and a payer's reconstructive criteria are confirmed, and prior authorization is secured, ahead of the operative date rather than after.
Match Documentation to Payer Criteria
The chart is checked against that specific payer's medical necessity requirements, such as visual field results, photos, or functional notes, before a claim is coded.
Apply Modifiers With Global Period Accuracy
Modifiers 58, 78, 79, 59, 62, and 50 are assigned based on the operative note and the timing of each procedure, not a default template.
Submit Clean Claims Within 48 Hours
Coded and documented claims are filed fast, while the encounter details are still complete and easy to verify.
Appeal Denials With Payer-Specific Evidence
Appeals are built around the exact reason for denial, whether that is medical necessity, bundling, or a missing authorization, using the payer's own coverage language.
Track AR Through Every Global Period
Open claims and staged procedures are followed until payment posts and reconciles against the contracted rate.
Why Practices Choose Thrive
A Plastic Surgery Billing Company Built Around One Distinction
Cosmetic versus reconstructive is not a footnote in plastic surgery billing. It is the entire job.
Specialty-Trained Coders, Not Generalists
Coders work reconstructive and cosmetic distinctions daily. That is different from a generalist biller learning modifier 58 for the first time on your claim.
Nationwide Payer Experience
Claims are billed across commercial, Medicare, and Medicaid payers in every state, not one regional network.
HIPAA Compliance and Audit Readiness
Every chart and claim is handled under the same compliance standard you would want reviewed in an audit.
Execution Over Dashboards
Effort goes into the coding, submission, and appeal work that actually moves a claim forward, not a portal you have to check yourself.
Transparent Reporting
You see clean claim rate, AR days, and denial reasons broken out by procedure, not a single blended number.
Connected Workflow
Eligibility, coding, denial management, and AR follow-up sit with one team, so an issue found in one area gets corrected upstream instead of repeating.
Talk to a Billing Expert
Talk to a Plastic Surgery Billing Expert
Get a Free 15-Minute Practice Revenue Review. We will look at your current clean claim rate, AR days, and denial reasons, and show you exactly where reconstructive claims are being reclassified as cosmetic or lost to a missed modifier.
Book Your Free Revenue Analysis
Schedule a 15-minute meeting to review where anesthesia claims, denials, payments, and AR follow-up are slowing collections.
🔒 100% confidential. We never sell your data. Privacy Policy
Frequently Asked Questions
Plastic Surgery Billing Questions, Answered
How much does plastic surgery billing cost?
Pricing is based on claim volume and procedure mix, since a panniculectomy claim takes more documentation work than a routine office visit. Thrive builds a custom fee schedule for each practice after reviewing current billing, rather than charging a flat rate that does not reflect what the claims actually require.
How long does onboarding take?
Most practices are fully onboarded in under a week. We review current claims, denial patterns, and coding to see where revenue is being lost, align our workflow to your existing EHR, and begin handling claims without disrupting how the front desk already operates.
Can you take over our existing AR and open claims?
Yes. We review current accounts receivable, including claims already stuck in appeal or sitting past 30 days, and fold it into ongoing follow-up. Older claims often need payer-specific appeal work rather than a simple resubmission, which is where specialty-trained coding makes the difference.
Do you bill cosmetic and reconstructive procedures differently?
Yes, and separating them correctly is central to plastic surgery billing. Reconstructive procedures with documented medical necessity are submitted to the payer with full coding and prior authorization support. Cosmetic procedures are billed directly to the patient with clear statements, so the two are never mixed on one claim.
How do you handle a denial marked not medically necessary?
We pull the payer's specific coverage criteria for that procedure and compare it against the chart to see what documentation was missing or unclear. The appeal is built around that exact gap, using supporting records such as photos or visual field results, rather than a generic resubmission.
Is this HIPAA compliant?
Yes. Every claim, chart reference, and piece of patient data is handled under HIPAA requirements, from how records are stored to how they move between your practice and the payer. Compliance is built into the daily workflow, not treated as a separate checklist.
How do we track our numbers?
You get regular reporting on clean claim rate, AR days, and denial reasons, broken out by procedure type rather than blended into one company-wide number. That makes it clear whether an issue is showing up in reconstructive claims specifically or across the practice.
Do you work with practices in every state?
Yes. Plastic and reconstructive surgery practices are billed the same way nationwide, but payer policy is not. We track state-specific Medicaid rules and regional commercial payer requirements so a practice in California and a practice in Texas both get billing built around their actual payer mix.
FREE REVENUE ANALYSIS
Find Out Where Your Plastic Surgery Practice Is Losing Revenue
If your practice is dealing with cosmetic and reconstructive procedure billing issues, medical-necessity denials, prior authorization delays, coding errors, or aging accounts receivable, we’ll review your billing workflow and show you where revenue is being lost—at no cost or obligation.
- HIPAA Compliant
- Certified Billing & Coding Support
- Certified Billing & Coding Team
- Nationwide Plastic & Reconstructive Surgery Billing Support