Medical Billing · Nationwide
Plastic & Reconstructive Surgery Medical Billing Services
Functional reconstructive surgery, federal WHCRA breast reconstruction defense, blepharoplasty visual field verification, and panniculectomy medical necessity appeals.
Aethera Healthcare Solutions provides full-service medical billing and revenue cycle management to plastic surgeons, craniofacial centers, and reconstructive microsurgery practices across the United States. We handle coding, claims, payment posting, denial management, and A/R follow-up end to end — so your team can stay focused on patient care while your revenue cycle runs cleanly.
Typical plastic & reconstructive surgery CPT range we work: 19357–19364, 15823, 15830, 19318, 14000–14061, 15100, 21120.
Why plastic & reconstructive surgery billing leaks revenue
Cosmetic vs reconstructive denials: Routine commercial payer rejections under cosmetic exclusion clauses (CARC CO-24) for blepharoplasty (15823) and breast reduction (19318) despite severe functional deficits
Schnur sliding scale tissue weight disputes: Payers refusing reduction mammaplasty prior authorizations when excised grams fall below arbitrary payer thresholds regardless of BSA calculation
WHCRA statutory compliance violations: Payers unlawfully denying contralateral breast symmetry surgery or nipple reconstruction following mastectomy in violation of the Women's Health and Cancer Rights Act
Panniculectomy clinical documentation rejections: Denials of CPT 15830 due to lack of 3+ months of conservative dermatologic treatment records or missing lateral apron photographs
How Aethera fixes it
Specialty-trained coders (CPC/CCS) code to the documentation
First-pass claim scrubbing against payer and NCCI edits
Proactive denial prevention and 72-hour denial work
Relentless A/R follow-up to drive days-in-A/R down
Eligibility and prior-auth verification before service
Transparent, real-time reporting in the provider portal
Free tools for your billing team
Use these any time — no login required.
Plastic & Reconstructive Surgery billing FAQ
How do you secure prior authorization for functional upper blepharoplasty (CPT 15823)?
Payers require taped and untaped visual field tests demonstrating at least a 30% or 12-degree superior field deficit, high-resolution anterior and lateral photographs showing pseudoptosis resting on the eyelashes, and documented physical impairment (e.g. chronic brow fatigue or peripheral vision loss while driving).
Are bilateral procedures covered under the Women's Health and Cancer Rights Act (WHCRA)?
Yes. Under federal law 29 U.S.C. § 1185b, any health plan offering mastectomy coverage must cover all stages of reconstruction on the diseased breast, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications including lymphedema.