Dermatology Medical Billing & Credentialing Services

End-to-End Billing and RCM Support for Dermatology Professionals

Dermatology medical billing is among the most complex in outpatient care due to the hybrid nature of cosmetic vs. medical procedures, frequent in-office surgeries, pathology, and biopsy coding, plus varying payer rules around medical necessity. If your claims are getting denied, underpaid, or audited, chances are your RCM partner isn’t specialized in dermatology billing.

At Oakview Medical Billing Solutions, we offer comprehensive billing and credentialing services tailored specifically for dermatologists, dermatopathologists, Mohs surgeons, and aesthetic clinics. From verifying medical necessity for lesion removals to ensuring modifiers are correctly applied to biopsies, we know how to maximize your revenue and keep your practice audit-free.

Common Dermatology Billing Challenges

1. Cosmetic vs. Medically Necessary Services

   • Payers often deny procedures like chemical peels, Botox, or laser treatments unless documented as medically necessary.

   • Correct use of ICD-10 codes to justify medical necessity is essential.

2. Multiple Procedure Billing (NCCI Edits)

   • Dermatology often involves multiple procedures on the same day. Proper use of Modifier 59 or XS is required to bypass bundling denials.

3. Biopsy & Pathology Pairing

   • Accurate linking of CPT codes for biopsies (e.g., 11102, 11103) with pathology (88304–88309) and documentation for location, size, and method.

4. Lesion Removal Documentation

   • Claims must specify whether the lesion is benign or malignant, its size, and location.

   • CPT Codes like 11400–11646 require exact coding based on lesion diameter and type.

5. Mohs Micrographic Surgery

   • Unique set of codes (17311–17315) requiring detailed intraoperative pathology and margins documented.

6. Phototherapy and Acne Treatments

   • Varying payer rules on coverage for phototherapy, laser therapy, and acne treatment require constant payer policy monitoring.

Dermatology Credentialing Services

Our team handles full-spectrum insurance credentialing and contracting for:

• General Dermatologists

• Pediatric Dermatologists

• Mohs Surgeons

• Dermatopathologists

• Aesthetic & Cosmetic Dermatology Clinics

• NPs & PAs in dermatology settings

We enroll you in commercial, government, and managed care plans like:

• Medicare / Medicare Advantage

• Medicaid (state-specific)

• Blue Cross Blue Shield (BCBS)

• UnitedHealthcare, Aetna, Cigna, Humana, Molina

• Optum, Tricare, CareSource, and more

Credentialing Services Include:

• CAQH profile management

• NPI (Type 1 & 2) registrations

• Medicare/Medicaid provider enrollment

• Payer-specific application completion

• Follow-ups, revalidations, recredentialing

• Insurance panel status updates & tracking