Compliance · Definition
Cosmetic vs medical: Definition
The determination of whether a dermatologic service is medically necessary and billable to insurance or elective and patient-paid.
This is a short definition only. The full explanation lives on cosmetic versus medical dermatology billing, which is the page to read if you are dealing with this on live claims.
Definition
The same CPT code can be either, depending on the documented indication.
Removal of a lesion that bleeds, is irritated by clothing or is suspicious is medical; removal for appearance is not.
For worked examples, payer rules and documentation requirements, read cosmetic versus medical dermatology billing. Return to the dermatology billing glossary.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report.