Dermatology Billing Services
Expert billing for dermatology practices with deep expertise in destruction codes, biopsy billing, and the critical modifier 25 requirements that maximize your reimbursement.
Maximize Medical Dermatology Revenue
Expert coding for medical and surgical dermatology nationwide
Why Dermatology Billing Requires Specialized Expertise
Dermatology billing sits at the intersection of medical necessity, proper procedure selection, and modifier mastery. A single patient visit can generate anywhere from $150 to $1,500+ in revenue depending on whether destruction codes, biopsies, and E/M services are coded and billed correctly.
The specialty faces unique coding challenges that don't apply to other fields. Destruction codes vary by lesion type, number, size, and technique. Bill 17110 (1-14 lesions) when you destroyed 15+ lesions, and you've left money on the table. Bill 17000 (first lesion) plus add-on codes incorrectly, and you're looking at bundling denials or underpayment.
Modifier 25 is the single most scrutinized modifier in dermatology. Payers deny E/M services performed on the same day as a procedure unless the documentation clearly demonstrates a separately identifiable evaluation. Many dermatologists see 30-40 patients daily with multiple performing both evaluations and destructions—getting modifier 25 right is critical to maintaining revenue.
The distinction between medical and cosmetic dermatology creates additional complexity. Some services are clearly cosmetic (laser hair removal, cosmetic Botox) and never billable to insurance. Others are clearly medical (acne treatment, skin cancer screening). But many procedures fall in gray areas where billing depends on diagnosis, documentation, and medical necessity. Bill cosmetic services to insurance, and you're committing fraud. Fail to bill legitimate medical services, and you're giving away revenue.
We built our dermatology billing practice around these unique challenges, with coders who understand lesion destruction coding, biopsy billing, and the documentation requirements that support modifier 25 usage. The result: 95% modifier 25 acceptance rate and maximum capture of every billable service.
Dermatology Billing Services We Specialize In
Destruction Coding
Benign lesions, premalignant lesions, warts. Proper code selection based on lesion count, size, and destruction method. Optimization of 17110 vs 17004 billing for maximum reimbursement.
Biopsy & Excision
Shave biopsies, punch biopsies, excisions with complex closure. Proper sizing documentation, pathology correlation, and modifier use for multiple biopsies same day.
Modifier 25 Compliance
Documentation review to support same-day E/M with procedures. Proper use of modifier 25 for separately identifiable services while avoiding unnecessary denials and audits.
Injection Procedures
Intralesional injections (steroid, chemotherapy), botulinum toxin for medical indications, trigger point injections. Medical vs cosmetic determination and proper diagnosis coding.
Medical vs Cosmetic Split
Clear protocols for billable medical services vs non-billable cosmetic services. Prevents fraud risk while ensuring all legitimate medical services are captured and billed.
Mohs Surgery Billing
Stage-by-stage billing, professional vs technical component split, reconstruction billing. Complete capture of all Mohs-related services including margin checks and closures.
Destruction Code Optimization: Maximizing Your Most Common Service
Lesion destruction is likely your highest-volume billable service, performed dozens of times daily across your practice. Small coding errors here compound into significant revenue loss because of the sheer volume involved.
The 17110 vs 17004 decision is where most money is lost. CPT 17110 covers destruction of benign or premalignant lesions (1-14 lesions) and pays approximately $110-150. CPT 17004 is the add-on code for 15+ lesions, adding another $15-25 per additional lesion. Many practices reflexively bill 17110 for every destruction session without counting lesions—leaving hundreds of dollars on the table when destroying 15, 20, or 30+ lesions in a single visit.
Payer policies on destruction codes vary significantly. Medicare has specific rules about what qualifies as "benign" vs "premalignant" and how to document medical necessity for destruction of common warts or other benign conditions. Some commercial payers bundle certain destructions into E/M services, while others pay separately. We track these payer-specific policies to optimize billing while maintaining compliance.
Multiple destruction methods same day require careful coding. If you perform both cryotherapy and electrosurgery on the same patient in the same session, separate billing may be appropriate with modifier 59. But many payers consider the destruction method irrelevant to payment—it's about the number of lesions destroyed, not the technique. We navigate these nuances to maximize appropriate payment.
For practices experiencing repeated destruction-related denials, our Denial Code Lookup Tool provides specific guidance on common denial codes and resolution strategies.
Dermatology CPT Codes & Reimbursement Rates
Understanding typical reimbursement helps practices prioritize proper documentation and coding. Here are common dermatology procedures with Medicare reimbursement rates (commercial rates typically 150-200% of Medicare).
Critical note on modifier 25: When an E/M service (99213-99215) is performed on the same day as a procedure, modifier 25 must be appended to the E/M code to indicate a separately identifiable evaluation. Without modifier 25, the E/M gets denied as included in the procedure payment. With improper use of modifier 25 (no documentation supporting separate service), you risk audit and overpayment recovery.
Modifier 25 Mastery: The Make-or-Break Modifier for Dermatology
If there's one modifier that defines dermatology billing success, it's modifier 25. Used correctly, it allows you to bill both an evaluation (99213-99215) and a procedure on the same day. Used incorrectly, it triggers denials and audits. Not used when appropriate, you leave $50-150 per patient visit on the table.
The rule is simple in theory: modifier 25 indicates a "separately identifiable" E/M service. But what does "separately identifiable" actually mean? It means the evaluation addressed issues beyond the decision to perform the procedure. A patient presents for skin cancer screening. You evaluate their entire body, document multiple lesions, discuss sun protection, and recommend follow-up. Then you destroy a premalignant lesion. That's two separate services: the comprehensive evaluation (99214 with modifier 25) and the destruction (17110).
What doesn't support modifier 25: Brief mention of the lesion being destroyed followed immediately by the destruction. Example: "Patient here for wart. Froze wart on left hand." That's one service (the destruction), not two. Billing an E/M with modifier 25 here results in denial or audit risk.
Common payer policies on modifier 25 vary. Medicare accepts modifier 25 when documentation supports it but audits high-volume users. Some commercial payers have automated edits that deny all modifier 25 claims above certain thresholds (e.g., 80% of encounters). Others accept it readily. We track payer-specific patterns and adjust documentation emphasis accordingly while maintaining compliant billing.
The $40k-60k annual loss mentioned earlier? Most of that comes from not billing E/M services when modifier 25 is clearly supported by documentation. Dermatologists see 30-40 patients daily. If even 10 of those visits involve both evaluation and procedure, that's 10 × $75-150 × 250 workdays = $187k-375k annually in legitimate E/M services. Miss modifier 25 on half of those, and you've lost $90k-180k. We help practices identify which visits truly warrant modifier 25, then ensure it's billed with proper documentation.
For more on our systematic approach to coding accuracy and denial prevention, see our RCM Intelligence framework.
Dermatology Billing FAQs
When can I bill modifier 25 with a procedure?
Modifier 25 is appropriate when you perform a separately identifiable evaluation beyond the decision to do the procedure. Examples include: comprehensive skin exam evaluating multiple lesions when only one is destroyed, evaluation of chronic conditions unrelated to the procedure, management of medications, or assessment of new complaints. The documentation must clearly show what was evaluated separately from the procedure decision. If the note only discusses the lesion being treated, modifier 25 is not supported.
How do I bill destruction of 20 lesions?
For destruction of 20 benign or premalignant lesions, use CPT 17111 (destruction of 15 lesions) plus CPT 17004 x 5 units (for the additional 5 lesions beyond 14). Total reimbursement approximately $160-210 for the 17111 plus $75-125 for the five 17004 units. Documentation must clearly indicate the total lesion count. Without documented count, payers may only reimburse for 17110 (1-14 lesions), resulting in underpayment of $50-100+ per session.
Do I need to bill shave biopsies differently than punch biopsies?
Yes. Shave biopsies use CPT 11102 (first lesion) and 11103 (additional lesions). Punch biopsies use CPT 11104 (first) and 11105 (additional). Incisional biopsies use 11106/11107. The code selection depends on the technique used, not the size or location. Using the wrong biopsy code won't typically result in denial but may result in incorrect reimbursement since different techniques have different payment rates.
Can I bill for both medical and cosmetic services in the same visit?
Yes, but they must be clearly separated. Medical services (covered by diagnosis like acne, rosacea, skin cancer screening) can be billed to insurance. Cosmetic services (chemical peels for appearance, laser hair removal, cosmetic Botox) cannot be billed to insurance and are patient responsibility. The challenge is services that can be either medical or cosmetic depending on indication—such as Botox for migraines (medical) vs wrinkles (cosmetic). Documentation must clearly support medical necessity for any service billed to insurance.
How does Mohs surgery billing work?
Mohs surgery billing depends on the number of stages and tissue blocks. First stage (up to 5 blocks) is CPT 17311. Each additional stage is 17312. Additional blocks beyond 5 in any stage are 17313 × units. The pathology interpretation is typically included in Mohs codes, but the reconstruction/closure is billed separately using appropriate repair codes (12031-13153). If closure is performed on a different day or by a different surgeon, different billing rules apply. Proper Mohs billing requires careful documentation of each stage and block count.
Stop Undercoding Your Dermatology Services
Destruction code errors, missed modifier 25 opportunities, and incomplete biopsy billing cost the average practice $40k-60k annually. Let's calculate your exact revenue gap.
Serving dermatology practices nationwide. Expert billing for medical and surgical dermatology.
A-Z Medical Billing & Consulting was founded by Zain Vally, who identified persistent revenue cycle inefficiencies while operating Vally Medical Group, a multi-location occupational medicine practice across Hawaii. The hands-on experience of managing billing operations for practices spanning multiple islands revealed systematic problems in how most billing services approach specialty-specific coding. Our dermatology billing expertise comes from years of working with dermatology practices to master destruction coding, modifier 25 compliance, and the medical-cosmetic service split. We built A-Z specifically to address these gaps through systematic prevention, aggressive pursuit of denied claims, and transparent reporting.