Plastic Surgery Billing Services

Plastic surgery billing sits between two worlds. Reconstructive work, such as breast reconstruction after cancer or wound closure, is billed to insurance. Cosmetic work is usually paid by the patient. Some procedures fall in between, like breast reduction or eyelid surgery for vision problems, where payers look closely at medical necessity.

That split shapes everything: documentation, photos, pre-authorization, and patient financial agreements. Reconstructive flaps and graft codes are detailed and depend on size and location. A plastic surgery billing company needs to handle insurance claims and self-pay packages side by side, while keeping global periods, modifiers, and implants straight.

Who this is for

• Plastic and reconstructive surgeons in private practice
• Surgeons who do breast reconstruction with oncology teams
• Practices that mix cosmetic and insurance-billed services
• Hand and craniofacial surgeons
• Surgeons who operate in hospitals, ASCs, and office-based suites

What gets billed

• Breast reduction
• Breast reconstruction with expanders, implants, or flaps
• Implant exchange and revision
• Abdominoplasty and body contouring after weight loss
• Skin grafts and tissue transfers
• Wound and defect closure
• Eyelid surgery for vision-related reasons
• Scar revision
• Hand and congenital procedures
• Consults and pre-operative visits
• Self-pay cosmetic procedures with package pricing

Commonly billed codes

Code	Type	What it covers
19318	CPT	Breast reduction
19357	CPT	Breast reconstruction using a tissue expander
11970	CPT	Replacing a tissue expander with a permanent implant
19364	CPT	Breast reconstruction with a free tissue flap
19380	CPT	Revision of a reconstructed breast
15830	CPT	Removal of the excess lower abdominal skin and tissue apron (panniculectomy)
15734	CPT	Muscle or skin flap on the trunk
14301	CPT	Adjacent tissue transfer to close a defect, mid-size area
15822	CPT	Upper eyelid skin removal
15823	CPT	Upper eyelid skin removal with heavy, drooping skin
N62	ICD-10-CM	Overgrowth of breast tissue
Z42.1	ICD-10-CM	Encounter for breast reconstruction after mastectomy

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in plastic surgery

Cosmetic versus reconstructive. Payers decide coverage based on medical need, not the name of the procedure. A biller experienced in plastic surgery makes sure notes, photos, and symptoms are in the chart before a request goes in.

Medical necessity for breast reduction and eyelid surgery. Many payers require symptoms, prior treatment, and photos or measurements, and some use specific criteria. Billers check each payer's policy and organize records before authorization.

Breast reconstruction after cancer. Federal law generally requires many plans to cover reconstruction after mastectomy. Billers confirm plan details, track staged procedures, and use modifiers such as 58 for planned later stages.

Flap and graft coding. Codes depend on the flap type, the size of the area, and the site. Billers read the operative note and measurements so that claims reflect the work done.

Global periods and staged care. Many procedures carry 90-day globals, and reconstruction often happens in stages. Billers track dates and apply modifiers 58, 78, and 79 when notes support them.

Implants and expanders. Devices may be billed by the facility or supplied by the practice, depending on setting. Billers verify who bills what and keep records of lot numbers.

Self-pay packages and refunds. Cosmetic cases come with deposits, financing, and revision policies. Billers keep clear financial records and separate self-pay from insured accounts.

How Westmont can help

• Matches your practice with vetted medical billing experts who work with plastic and reconstructive surgeons
• Connects you with end-to-end revenue cycle support for insurance and self-pay accounts
• Helps you find denial management support for medical necessity denials
• Connects you with credentialing support for surgeons and surgical sites
• Offers a path to request a quote based on your service mix

Frequently asked questions

How do payers decide if a procedure is cosmetic?

Payers look at the diagnosis, symptoms, prior treatment, and documentation, not just the procedure name. Surgery that restores function or repairs damage from illness or injury may be covered, while purely cosmetic changes usually are not. A plastic surgery billing company helps gather the records a payer asks for.

Is breast reconstruction after mastectomy covered?

Federal law generally requires many group health plans that cover mastectomy to also cover reconstruction, including related procedures. Plan details differ, and some plans are exempt. Staged procedures and revisions may need separate authorization, so verify benefits and current rules before surgery.

How are staged reconstruction procedures billed?

Each stage is billed with the code that matches the work done. If a later procedure is planned and related to the first, modifier 58 may apply during the global period. Payers differ, and the note should show the staging plan from the start.

Can we bill cosmetic and insurance services in one visit?

Yes, but they should be documented and billed separately. The patient pays for the cosmetic part, while insurance is billed only for covered services. Clear consent forms and financial agreements help prevent disputes. Confirm payer rules about collecting from patients for noncovered services.

What documentation helps with breast reduction approval?

Payers commonly ask for symptoms, treatments tried, height and weight, and an estimate of the tissue to be removed. Photos may also be needed. Criteria differ by payer, so check each policy and submit complete records to avoid delays.

Related billing services

• General Surgery
• Surgical Oncology
• Dermatology
• Wound Care / Hyperbaric Medicine
• Ambulatory Surgery Centers (ASC)
• Oral & Maxillofacial Surgery