Dermatology billing
Dermatology billing services
We handle billing for dermatology practices, from skin checks and biopsies to excisions, destructions and Mohs surgery. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and pricing starts at 2.5% of collections.
- Excisions coded after pathology, by size including margins
- Modifier 25 and 59/XS used only when the note supports them
- Medical vs cosmetic services separated before the claim goes out
Why dermatology billing is different
Dermatology claims depend on size, method and pathology
A single dermatology visit can include an exam, several lesions and more than one procedure. Each lesion is coded on its own, and the final code often depends on the pathology report.
Biopsy by method
Skin biopsies are coded by technique: tangential (11102/11103), punch (11104/11105) or incisional (11106/11107). When several methods are used in one visit, only one primary code is reported and the rest are add-ons.
Excisions wait for pathology
Benign excisions (11400–11446) and malignant excisions (11600–11646) pay differently. The code is chosen by excised diameter including margins, and benign vs malignant is confirmed from the pathology report.
Repairs and closures
Simple closure is included in an excision. Intermediate or complex repairs (12031–13153) are billed separately when documented, with size measured after closure.
Destruction of lesions
Premalignant lesions such as actinic keratoses are coded by count (17000, 17003, 17004). Benign lesions such as warts use a different code family, and payers may limit coverage.
Modifiers 25 and 59
An E/M on the same day as a minor procedure needs a separate, documented reason and modifier 25. Procedures on separate lesions may need modifier 59 or an X modifier such as XS. Payers audit both closely.
Cosmetic vs medical
Removing a benign lesion for appearance is usually not covered. Medicare patients need an Advance Beneficiary Notice before a service that may be denied, so the practice can bill the patient if it is.
Common codes
Dermatology codes we review on every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 11102–11107 | Skin biopsy by tangential, punch or incisional method | One primary code per visit; add-ons for extra lesions |
| 11400–11446 | Excision of a benign lesion, by site and size | Size includes margins; pathology confirms benign |
| 11600–11646 | Excision of a malignant lesion, by site and size | Pathology report on file before billing |
| 17000 / 17003 / 17004 | Destruction of premalignant lesions, by count | 17004 is not billed with 17000 or 17003 |
| 17311–17315 | Mohs micrographic surgery, by site and stage | Stages and blocks match the Mohs report |
| 12031–13153 | Intermediate and complex repair | Repair length and type documented separately from the excision |
| 99202–99215 | New and established office visits | Modifier 25 only when separate from the procedure |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Dermatology denials we stop before they happen
Most dermatology denials come from modifier use, lesion counts and services payers see as cosmetic. We check each claim before it goes out.
- Modifier 25 on an E/M that does not show a separate problem
- Multiple lesions billed without the modifier or add-on that shows they are distinct
- Excisions billed as malignant before the pathology report confirms it
- Destruction codes billed together that are not meant to be combined
- Cosmetic services billed to insurance, or Medicare services billed without a signed ABN
- Services inside a 10-day global period billed without the right modifier
What we handle
Everything between the skin check and the payment
- Insurance eligibility and benefits checks before visits
- Charge entry and coding review of lesion codes, repairs and modifiers
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for dermatologists, PAs and NPs
- Patient statements and balance tracking
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for dermatology practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing.
Common questions
Do you wait for pathology before billing an excision?
Yes, for lesion excisions. Benign and malignant excisions use different codes, so we bill once the pathology report confirms the diagnosis. Biopsies can go out sooner because they are coded by method, not by result.
Can we bill an office visit and a biopsy on the same day?
Yes, when the visit addresses a separate problem beyond the decision to biopsy and is documented separately. It is then billed with modifier 25. Payers review this closely, so we check the note first.
How do you bill several biopsies done different ways?
Only one primary biopsy code is reported per visit. Other lesions are reported with add-on codes for the method used, following the CPT hierarchy for tangential, punch and incisional biopsies.
Do you bill Mohs surgery?
Yes. We code Mohs by site and stage (17311–17315) and bill any repair separately when it is documented. We make sure the stages billed match the Mohs report.
How do you handle cosmetic procedures?
Cosmetic services are usually not covered by insurance. We keep them off insurance claims, and for Medicare patients we check that a signed ABN is on file when a service may be denied, so the practice can bill the patient.
Is dermatology your main specialty?
No. Our core focus is behavioral health, and we bill dermatology and other specialties with the same team, the same promises and CPB-certified billers on the team.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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