Plastic surgery · Reconstructive
Reconstructive only — and every case needs a defensible pre-auth and documentation trail.
We serve reconstructive plastic surgery practices — post-mastectomy reconstruction, burn and trauma repair, medically necessary scar revision. Pre-authorization and medical-necessity documentation are the whole game.
Who this serves: Reconstructive plastic surgery practices, breast reconstruction programs, burn and trauma reconstruction teams, and hospital-based reconstructive departments.
Reconstructive plastic surgery lives and dies on the pre-auth. A scheduled breast reconstruction that wasn't pre-authorized correctly becomes a $20,000 denial that the patient hears about at check-in. A scar revision without documented medical necessity becomes a cosmetic cash-pay after the fact.
The billing itself isn't conceptually hard. The work is all upstream: the PA submission, the medical-necessity documentation, the payer-specific nuances about what counts as reconstructive versus cosmetic.
We don't serve cosmetic plastic surgery. It's a fundamentally different business. But reconstructive — we've built the workflow for.
What separates a specialty-fluent biller from a generalist.
Post-mastectomy reconstruction
- Breast reconstruction (19357, 19361, 19364, 19366, 19367–19369)
- Tissue expander placement (19357)
- Nipple-areola reconstruction (19350)
- Fat grafting when medically necessary (15771, 15772)
Burn & trauma
- Burn debridement (15002–15005, 15040)
- Grafts and flaps (15100–15278)
- Facial trauma repair (21310–21497)
- Hand and extremity reconstruction
Scar revision & skin
- Scar revision (13100–13160) with medical necessity
- Keloid treatment (11900, 11901)
- Benign and malignant lesion excision
- Complex repair coding
Pre-auth operations
- PA initiation at scheduling
- Payer-specific medical-necessity templates
- Appeals management for initially denied PAs
- Peer-to-peer coordination when required
PA as an operations discipline
Not a clerical task. Staffed, tracked, and measured. Every case has a PA owner.
Documentation templates
Medical-necessity templates per procedure, payer, and state — so the documentation supports the code.
Reconstructive-only focus
We don't split attention with cosmetic. Every workflow is built for the reconstructive case.
Days 1–30 · Audit
PA denial audit. Medical-necessity documentation sampling. Appeals inventory.
Days 31–60 · Install
PA workflow live. Documentation templates deployed. Appeals discipline in place.
Days 61–90 · Lift
PA denials below 5%. Appeals turn-around inside 48 hours. Clean-claim rate at or above 96%.
Ownership structure doesn’t change the billing mechanics. The practice is the unit we serve.
- Reconstructive plastic surgery practices
- Breast reconstruction programs
- Burn and trauma reconstruction teams
- Hospital-based reconstructive departments
Free audit
Curious how much you're leaving on the table in plastic surgery?
Our free 30-day audit tells you — specific codes, specific payers, specific dollar amounts. No contract. You keep whatever we find.