Plastic surgery billing with coverage expectations made clear.
Reconstructive and cosmetic work can sit side by side in one practice, but the payment arrangements may be very different. We help your team separate insurance claims from direct-pay services and assemble the documentation needed for the services submitted to a health plan.
- ClaimsDocumentation review
- A/RPayer follow-up
- ReportsClear next actions
Three ways Plastic and Reconstructive Surgery claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Coverage is assumed from the procedure name
A plan’s decision can depend on the reason for surgery and supporting records. We track benefit and authorization requirements without promising reimbursement.
- The record does not explain the reconstructive purpose
A payer may request clinical evidence or prior treatment information. We identify the requested documentation and coordinate its submission with the practice.
- Insurance and direct-pay balances are mixed
Payments and patient responsibilities should follow the actual arrangement. We help keep those accounts distinct so patients receive clearer statements.
What we bill for plastic and reconstructive surgery teams
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Plastic and Reconstructive Surgery accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- Separate the payment pathways
We identify which services the practice submits to insurance and which follow an agreed direct-pay arrangement.
- Track the required supporting records
Available authorization and clinical documentation are matched to the planned or completed service.
- Review the surgical claim
The procedure record, practitioner information and related services are checked together.
- Reconcile payment and patient responsibility
We examine the payer response before moving an unresolved balance to patient follow-up.
Included for plastic and reconstructive surgery teams
- Charge review against the clinical record
- Eligibility and benefit checks within the agreed scope
- Submission and rejection follow-up
- Payer denial review and supported appeals
- Payment posting and balance reconciliation
- Aged receivable review
- Specific documentation queries for your team
- Reporting on outstanding work and next actions
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Plastic and Reconstructive Surgery billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Plastic and Reconstructive Surgery service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat plastic and reconstructive surgery teams ask
Is reconstructive surgery always covered?
No. Coverage depends on the plan, clinical circumstances and requirements for the specific service.
Can you submit cosmetic work as reconstructive?
Only the service and purpose documented by the clinician can be reported. We do not change the description to obtain coverage.
Can you support a mixed insurance and cosmetic practice?
Yes. We agree separate workflows for insurance claims and direct-pay services so responsibilities remain clear.
Let’s review your plastic and reconstructive surgery billing
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.