New York City, NY
Dermatology Billing Services in New York City
Dermatology billing for practices across Manhattan, Brooklyn, Queens, the Bronx, Long Island and Westchester. New York adds no-fault, workers' compensation and union plans on top of an already dense commercial market, each with filing clocks shorter than anything else in the country.
Area served
Manhattan, Brooklyn, Queens, the Bronx, Long Island and Westchester
Medicare contractor
National Government Services (Jurisdiction K)
Medicaid program
NY Medicaid and its managed-care plans
Speciality
Dermatology, Mohs surgery and dermatopathology only
What dermatology billing looks like in New York City
New York is the only market where a dermatology practice routinely bills four fundamentally different claim types: standard commercial, Medicaid managed care, no-fault and workers' compensation. The last two use their own forms, their own fee schedules and filing windows measured in days rather than months. Missing one is unrecoverable.
Union and Taft-Hartley funds hold a large share of the working population, and their benefit design and administrators differ from the commercial plans practices are used to. Sending the claim to the plan name on the card is often wrong.
Manhattan practices also carry a heavy cosmetic mix alongside medical dermatology, which raises the same medical-versus-cosmetic separation problem seen in Los Angeles.
The payers that decide your New York City revenue
National Government Services (Medicare Part B, Jurisdiction K)
Local coverage determinations for the New York Part B book.
No-fault and workers' compensation carriers
Separate forms, fee schedules and short statutory filing windows.
Union and Taft-Hartley funds
Distinct administrators and benefit rules that differ from commercial plans.
Empire, UnitedHealthcare, Aetna and Healthfirst
Dense commercial and managed-Medicaid market with aggressive evaluation and management review.
New York rules that change how your claims are filed
Coverage policy, filing windows and payment deadlines are set at state and contractor level. These are the New York specifics we bill against. Payer policy changes, so confirm the current version before citing one in an appeal.
- Medicare coverage policy
- National Government Services Jurisdiction K covers New York. Its benign lesion removal and Mohs coverage articles are the reference for downstate surgical dermatology documentation.
- Medicaid program
- New York Medicaid managed care through Fidelis Care, Healthfirst, MetroPlusHealth, EmblemHealth and UnitedHealthcare Community Plan.
- Timely filing
- Medicare: 12 months. New York Medicaid: 90 days from date of service for participating providers. Commercial: commonly 90 to 120 days downstate.
- Prompt-pay statute
- New York Insurance Law §3224-a requires payment of an undisputed electronic claim within 30 days (45 days for paper), with interest and Department of Financial Services complaint rights when the window is missed.
Denials we see most in New York City
- No-fault and workers' compensation claims denied on timeliness because the short filing window lapsed.
- Union-fund claims sent to the wrong administrator and rejected as non-member.
- Modifier 25 downcoding on same-day procedure visits.
- Cosmetic contamination when an aesthetic service was not separated from the medical encounter.
The controls we run against them
- Specialty claim forms and fee schedules maintained for no-fault and workers' compensation, with filing alarms set well inside the statutory window.
- Union and fund routing verified against the administrator rather than the card logo.
- Modifier 25 documentation test before submission with an appeal pipeline for downcodes.
- Split-encounter workflow separating self-pay cosmetic charges from billable medical services.
Services New York City practices use most
Dermatology Medical Coding Services
Certified dermatology coding for lesion destruction, excisions, repairs, biopsies and E/M. Correct CPT selection, modifier 25 and 59 discipline, and documentation feedback.
Mohs Surgery Billing and Coding
Mohs micrographic surgery billing: stage and block sequencing, 17311–17315, repair and flap coding, and payer-specific bundling rules handled by dermatology-only staff.
Dermatopathology Billing Services
Dermatopathology billing for in-house and reference labs: 88304–88305 specimen counting, professional and technical component splits, and immunohistochemistry and special stains.
Dermatology Denial Management and Appeals
Dermatology denial management: root-cause categorisation, payer-specific appeal letters with clinical citations, and fixes pushed upstream so the same denial stops recurring.
Dermatology Eligibility and Prior Authorization
Prior authorization for biologics, phototherapy, PDT and surgical dermatology, plus eligibility and benefit verification before the visit so treatment is not delayed or denied.
Dermatology A/R Recovery and Patient Billing
Aged A/R recovery for dermatology practices plus patient statements, payment plans and cosmetic-versus-insurance balance handling, with full transparency on what is collectable.
Dermatology Credentialing and Payer Enrollment
Provider credentialing and payer enrollment for dermatology practices: CAQH maintenance, Medicare and commercial enrollment, revalidation tracking and group roster updates.
Frequently asked questions
Do you bill no-fault and workers' compensation for dermatology?
Yes. Both use their own forms and fee schedules and have filing windows far shorter than commercial plans, so they are tracked on separate clocks with alarms set inside the statutory deadline.
Why do union-plan claims keep rejecting?
Usually because the claim went to the insurer printed on the card rather than the fund administrator that actually adjudicates it. We verify the administrator before submission.
Can you handle a practice with both cosmetic and medical dermatology?
Yes. Cosmetic services are captured as self-pay with their own consent and pricing, and medical services are billed only where documentation independently supports medical necessity.