Compliance
Cosmetic vs medical
The determination of whether a dermatologic service is medically necessary and billable to insurance or elective and patient-paid.
What it means in dermatology
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.
The determination has to be made and documented before the service, with a signed acknowledgment when the patient is accepting financial responsibility.
Why it matters to your revenue
Billing a cosmetic service as medical is a compliance exposure, not merely a denial risk.
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 — including where terms like this one are costing you money.
Request a free claims audit