Billing and coding for medical, surgical, Mohs and cosmetic dermatology practices, from solo offices to multi-location groups with in-house dermatopathology.
A dermatology schedule packs a visit, two biopsies and a destruction into fifteen minutes, and every one of those lines has its own rule. Miss modifier 25 and the visit is gone. Size an excision from the lesion alone and the claim pays one tier low. Same-day procedures with an E/M visit were denied for modifier 25 on 14% of claims (Luxen claim audit). Our full-service medical billing team codes each encounter against the note before it leaves your system.
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Dermatology billing services handle coding, claims, denials and patient billing for medical, surgical, Mohs and cosmetic dermatology practices. The work turns biopsies, excisions, destructions and Mohs stages into clean claims and keeps cosmetic care off them. Medicare pays $667.02 nationally in 2026 for a first Mohs stage on the face, CPT 17311.
We bill for four kinds of dermatology practice, and each loses money in a different place.
Many of these practices also bill other service lines: an in-office dermatopathology lab, phototherapy and excimer laser, office surgery suites and teledermatology photo reviews. We set up each line with its own charge rules, so a pathology read or a light treatment is not held up by a visit coding question.
Dermatology claims are small and frequent, so the same error repeats hundreds of times a month. These are the patterns our reviews find most, with 2026 national Medicare non-facility amounts.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Visit plus biopsy on the same day | 99213 with 11102 | Modifier 25 missing, or the note does not show work beyond the biopsy decision | $95.19 visit denied | Same-day procedures with an E/M visit were denied for modifier 25 on 14% of claims (Luxen claim audit) |
| Malignant excision on the face | 11642 vs 11643 | Code picked from lesion size before margins were recorded | $49.10 underpaid | Excision codes were selected before final lesion size was documented on 10% of claims (Luxen claim audit) |
| Mohs case with slides billed by the surgeon | 17311 with 88305 | Pathology is part of the Mohs code and denies | $70.14 denied, plus rework | Coding and modifier errors caused 21% of denials (Luxen claim audit) |
| Seborrheic keratosis removal | 17110 | No bleeding, itching or irritation documented, so the payer treats it as cosmetic | $111.22 denied or shifted to the patient | 19% of denied claims were never reworked or appealed (Luxen billing reviews) |
| Mohs with a second stage and repair | 17312, 13131 | Stage count or repair length missing from the note | $402.81 for the stage, $192.22 for the reduced repair | The top three denial reasons accounted for 58% of denied dollars in the average practice (Luxen billing reviews) |
Most dermatology revenue comes from a short list of procedure families. Each has a counting rule that decides the code, and a global period that decides what else you can bill for the next 10 days.
| CPT | Service | Global days | 2026 Medicare, national non-facility |
|---|---|---|---|
| 11102 / 11103 | Tangential biopsy, first lesion / each additional | 000 / add-on | $95.53 / $48.77 |
| 11104 / 11105 | Punch biopsy, first lesion / each additional | 000 / add-on | $121.25 / $60.46 |
| 11106 | Incisional biopsy, first lesion | 000 | $151.31 |
| 11642 / 11643 | Malignant excision, face, 1.1 to 2.0 cm / 2.1 to 3.0 cm | 010 | $266.87 / $315.97 |
| 17000 / 17003 | Premalignant destruction, first lesion / each of lesions 2 to 14 | 010 / add-on | $66.47 / $6.35 each |
| 17004 | Premalignant destruction, 15 or more lesions | 010 | $162.33 |
| 17110 / 17111 | Benign destruction, 1 to 14 lesions / 15 or more | 010 | $111.22 / $129.93 |
| 96920 | Excimer laser for psoriasis, under 250 sq cm | 000 | $137.95 |
Amounts are the CMS 2026 relative value units times the $33.4009 conversion factor, before locality adjustment.
When different biopsy methods are used on the same day, only one primary code is reported: incisional over punch over tangential. Every other lesion goes on an add-on code for its own method. Reporting two primary codes is a common reason for a line to deny.
The excised diameter is the lesion's greatest clinical diameter plus the narrowest margin required on each side, measured before the excision. A 1.2 cm lesion with 0.5 cm margins is a 2.2 cm excision, which moves 11642 to 11643. Pathology size is not a substitute. A biopsy of the same lesion at the same encounter is included in the excision under NCCI Chapter 3.
17004 replaces 17000 and 17003 when 15 or more premalignant lesions are treated. It is never billed with them. Our certified coders check lesion counts against the note, because counts in templates often carry forward from the last visit.
Mohs micrographic surgery pays well and gets reviewed closely. The surgeon acts as both surgeon and pathologist, so the codes carry rules no other dermatology service has.
NCCI Chapter 3 bundles the biopsy, the excision and the pathology (88300 to 88309, 88329 to 88332) into the Mohs code. A diagnostic biopsy and frozen section done before Mohs on a suspected cancer can be billed with modifier 59, XS, XU or 58. Repairs, grafts and flaps are billed separately. Adjacent tissue transfer (14000 to 14350) already includes excision and repair of the same site, so those are not added. Practices that also run a dermatopathology lab should read our pathology billing guide for the global, 26 and TC splits.
| Line | Code | 2026 national non-facility |
|---|---|---|
| First stage, face | 17311 | $667.02 |
| Second stage | 17312 (add-on, no reduction) | $402.81 |
| Complex repair | 13131 at 50% multiple procedure rate | $192.22 |
| Total allowed | $1,262.05 |
Medicare contractors publish Mohs LCDs built on appropriate use criteria: tumor type, size, location and immune status. The note must say why Mohs was chosen over standard excision. WPS applies LCD L35494 to practices in Michigan and Missouri. Novitas applies LCD L34961 in states that include Texas.
Two decisions shape almost every dermatology claim: is the visit separately billable, and is the service covered at all.
The decision to perform a minor procedure is part of the procedure payment under NCCI Chapter 1. A visit is billable with modifier 25 only when the note shows a significant, separately identifiable service, for example managing acne or a rash in addition to the biopsy of a new lesion. A patient booked only for a known wart destruction does not support a visit.
Since 2025, G2211 pays with a modifier 25 visit only when the same-day service is an annual wellness visit, a vaccine administration or a Part B preventive service, according to the CMS G2211 FAQ. Adding G2211 to a visit billed with a skin biopsy draws a denial for $17.37.
Practices that also do reconstructive work face the same split; our plastic surgery billing page covers it for flap and breast cases.
The rule: services Medicare never covers, including cosmetic surgery, need no ABN. A voluntary ABN is allowed and billed with GX, per CMS MLN006266. The cost: practices file claims that should never exist, then chase the denials. Eligibility and coverage errors caused 24% of denials (Luxen claim audit).
The rule: lesion removal codes include a biopsy of the same lesion at the same encounter, per NCCI Chapter 3. The cost: $95.53 per tangential biopsy recouped on audit. Coding and modifier errors caused 21% of denials (Luxen claim audit).
The rule: Mohs codes include the pathology, so 88305 on Mohs tissue denies, per NCCI Chapter 3. The cost: $70.14 per specimen plus rework time. The top three denial reasons accounted for 58% of denied dollars in the average practice (Luxen billing reviews).
The rule: the excised diameter adds the narrowest margin on each side, per CPT guidance summarized by AAFP. The cost: $49.10 on a facial malignant excision coded one tier low. Excision codes were selected before final lesion size was documented on 10% of claims (Luxen claim audit).
The rule: with modifier 25, G2211 pays only alongside a wellness visit, vaccine administration or Part B preventive service, per the CMS FAQ. The cost: $17.37 denied per visit, repeated across a full clinic day. Denials like this persist: 63% of practice managers could not name their top three denial reasons (Luxen Practice Manager Survey 2026).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Dermatology practices run on specialty EHR and PM systems built for lesion mapping, photos and Mohs documentation: ModMed EMA, Nextech, EZDerm and PatientNow for cosmetic scheduling, with athenahealth, eClinicalWorks, NextGen and Epic in multispecialty and hospital-affiliated groups. Dermatopathology labs often run a separate lab information system, and Mohs surgeons keep maps and stage records inside the EHR or a dedicated Mohs module.
We work inside the system you already have, with access granted after the BAA is signed. No migration. 38% had changed EHR or practice management system in the past five years (Luxen Practice Manager Survey 2026), and each switch resets templates, fee schedules and staff habits.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Mohs stages, tissue blocks, and pathology documentation were not consistently reviewed together. Luxen introduced a case-level audit, reduced Mohs billing errors from 12.6% to 3.1%, and recovered $48,900.
Practice Administrator, dermatology and Mohs surgery group
Cosmetic services and insurance-covered dermatology procedures were posted through the same workflow. Luxen separated patient-pay and insurance charges, reducing rebilling and refund cases by 68%.
Revenue Cycle Manager, multi-location dermatology practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Two parts of the dermatology revenue cycle sit outside the claim itself: drug access and the patient's share.
Biologics for atopic dermatitis and psoriasis run on 12-month approvals. The UnitedHealthcare Dupixent policy approves atopic dermatitis for 12 months and reauthorizes only with a documented positive response. Missing or invalid prior authorization caused 17% of denials (Luxen claim audit). We track each renewal date with our eligibility and prior authorization team, so therapy does not stop at month 13.
Uninsured and self-pay patients must get a Good Faith Estimate when a service is booked at least 3 business days ahead or when they ask. A bill $400 or more above the estimate can be disputed, per CMS.
No federal rule sets a deadline; your financial policy does. The three national credit bureaus do not report medical collections under $500 and wait a year before reporting any medical debt, per the CFPB. Plain-language statements plus text reminders raised patient collections 22% across 14 practices (Luxen client data). Our patient billing service sends those statements and reminders.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month with 30 days notice, and no setup or exit fee. Example: a three-provider dermatology and Mohs practice collecting $150,000 a month from insurance.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% | In-house at 7.9% |
|---|---|---|---|---|
| Medical dermatology visits and procedures | $80,000 | $2,400 | $4,800 | $6,320 |
| Mohs surgery and repairs | $55,000 | $1,650 | $3,300 | $4,345 |
| In-office dermatopathology | $15,000 | $450 | $900 | $1,185 |
| Total | $150,000 | $4,500 | $9,000 | $11,850 |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews), or $11,850 a month here. Even at 6%, Luxen costs $2,850 less each month. Your rate depends on claim volume and case mix.
Ask the last question first. 42% of practice managers said nobody owns denial follow-up full time (Luxen Practice Manager Survey 2026).
| Partner type | Dermatology coding depth | Denial follow-up | Works in your EHR | Typical cost |
|---|---|---|---|---|
| In-house biller | Depends on one person | Competes with front desk work | Yes | Salary plus benefits and turnover |
| Generalist billing company | Often thin on Mohs and lesion rules | Varies | Often | Percent of collections |
| Dermatology-only company | Strong | Varies | Often | Percent of collections |
| EHR vendor RCM | Tied to vendor templates | Varies | Only their own system | Percent of collections plus software |
| Luxen | Certified coders, dermatology rules checked per claim | Owned by a named team, reported monthly | Yes, no migration | 3% to 6% of collections |
To see how partners compare in your state, compare medical billing companies near you. If old claims are piling up, our denials and AR recovery team starts with the oldest dollars. We recovered 61% of the dollar value of claims aged 90 to 180 days that practices had stopped working (Luxen client data).
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Modifier 25 is the most common, because dermatologists often do a biopsy or destruction at the same visit where they evaluate other problems. It only holds when the note shows a significant, separately identifiable service beyond the decision to do the procedure. Modifiers 59 and XS follow closely for procedures on separate lesions.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee. For a practice collecting $150,000 a month, that is $4,500 to $9,000. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in our billing reviews.
Plan on about 2 weeks from signed BAA to working claims, with first recovered payments in about 3 weeks. Median time from signed BAA to first claims worked was 9 business days across our client practices. We work the oldest open claims first so timely filing limits, 12 months for Medicare, do not expire during the change.
The best system is the one your providers already chart in well, because lesion maps, photos and Mohs records feed the codes. Dermatology practices commonly use ModMed EMA, Nextech, EZDerm, athenahealth or eClinicalWorks. Luxen works inside any of them after the BAA is signed, with no migration.
No. NCCI Chapter 3 includes pathology codes 88300 to 88309 in the Mohs codes 17311 to 17315, so billing them together is denied. A diagnostic biopsy with frozen section on a suspected cancer before Mohs can be billed with modifier 59, XS, XU or 58.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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