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Cosmetic Services

Karin Posted Wed 25th of January, 2012 01:16:12 AM

If you have a patient that comes in for a scheduled 96567 Photodynamic Light therapy can you not bill the procedure code and instead bill the e/m code?? There is the issue of cosmetic versus diagnostic and all that fun stuff. I just need it in writing that this is inappropriate and is hiding the procedure from insurance. What is the best way to handle cosmetic services in a Dermatology practice versus billing to insurance. Thanks!!

SuperCoder Answered Thu 16th of February, 2012 11:15:59 AM

Most of the cosmetic services are nonbillable by insurances, but some of services that can covered and reimbursable. For noncovered cosmetic services, there is no way to bill it. If it falls under covered services, then only you should bill and expect for reimbursable.
Refer this CMS link for Billing and Coding Guidelines for Cosmetic Services that may help you:
http://www.cms.gov/medicare-coverage-database/lcd_attachments/30733_1/L30733_GSURG032_CBG.pdf
Another link: http://personalinsure.about.com/cs/healthinsurance1/a/aa062303a_2.htm

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