Plastic Surgery EHR and AI Medical Billing Software

Plastic surgery splits into reconstructive care billed to insurance and cosmetic care paid by the patient. XEHR keeps the two cleanly apart.

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Chart · Office visit

Lastname, Firstname M. Sample patient · DOB 01/01/1980 · Commercial

Eligible

BP128/82

HR72

BMI26.4

Temp98.6

Progress noteAI Scribe draft

Planning reconstruction after mastectomy.

Z42.1 Breast reconstruction after mastectomy

ReviewSign note

Diagnosis carried to the claimZ42.1

THE HARD PARTS

What makes plastic surgery billing hard

Cosmetic or medically necessary

Insurance pays only for medically necessary reconstruction, and the documentation must show why.

Photos as evidence

Approvals often depend on photographs and measurements in the record.

Self-pay quotes and deposits

Cosmetic patients need clear quotes, deposits and payments.

WHERE THE WORK HAPPENS

How plastic surgery care is delivered and billed

Plastic surgeons do both reconstructive work billed to insurance and cosmetic work paid by the patient, often in the same practice. Reconstruction after cancer, trauma and burns is billed with the facility place of service when done in a hospital or surgery center; cosmetic procedures are priced and collected directly. Keeping the two separate, with clear documentation of medical necessity, is central to clean billing.

What payers check on plastic surgery claims

Breast reconstruction after mastectomy is covered by law for most group health plans, including surgery on the other breast for symmetry.
Breast reduction and eyelid surgery are covered only with documented medical criteria such as symptoms, measurements or visual field tests.
Cosmetic procedures are not billed to insurance, and a patient must know in advance that they will pay.
Wound repairs are billed by length and complexity, so the note must record both.
Burns are coded by site, degree and extent of body surface.

Common plastic surgery diagnoses ICD-10-CM

Z42.1	Encounter for breast reconstruction following mastectomy
N62	Hypertrophy of breast
L90.5	Scar conditions and fibrosis of skin
S61.411A	Laceration without foreign body of right hand, initial encounter
H02.831	Dermatochalasis of right upper eyelid
T21.20XA	Burn of second degree of trunk, unspecified site, initial encounter

Examples only. The provider chooses the code that matches the documented diagnosis, and XEHR checks it against the note and the payer's rules before the claim goes out.

A VISIT ON XEHR

A plastic surgery visit, start to payment

1
Decide who pays

The consultation documents whether the procedure is reconstructive or cosmetic, with photos and measurements where payers require them.
2
Approve or quote

Reconstructive cases get prior authorization prepared from the record; cosmetic cases get a written price.
3
Operate and document

The operative note records each procedure, area and technique.
4
Bill or collect

Insurance claims carry the facility place of service; cosmetic fees are collected and recorded separately.

How XEHR helps

From the plastic surgery visit to the payment

Medical necessity documentedTemplates capture the findings that support coverage.
Images in the chartClinical photos are stored with the visit, private to your practice.
Patient paymentsSelf-pay balances, statements and online payments are handled in XEHR.
AI that waits for youThe AI drafts notes and prepares claims; your providers sign and your billers approve.

Claim · CMS-1500

Sample claimLastname, Firstname M. · DOS 03/04/2026

Scrub passed

Scrubbed
Submitted
Accepted
Paid

Service	Dx	Units	Charge
Office visit	E11.9	1	145.00
A1c test	E11.9	1	28.00
Total			173.00

ERA postedPayment applied, no re-keying

Agentic AI for plastic surgery

AI medical billing for plastic surgery practices

XEHR is an agentic EHR: AI agents do the administrative work around every plastic surgery visit, and your team approves what matters. How agentic AI works

Before the claim leaves

The claim-check agent looks for

Breast reconstruction after mastectomy is covered by law for most group health plans, including surgery on the other breast for symmetry.
Breast reduction and eyelid surgery are covered only with documented medical criteria such as symptoms, measurements or visual field tests.
Cosmetic procedures are not billed to insurance, and a patient must know in advance that they will pay.
Wound repairs are billed by length and complexity, so the note must record both.

Around the visit

Agents run on their own

Coverage checked before each plastic surgery visit
The visit note drafted for the provider to sign
Insurance payments matched and posted
Open claims tracked, denials read and appeals drafted

People decide

Your team stays in charge

Providers sign every note
Billers approve every claim and appeal
Staff submit prior authorizations
Any check can be overridden, with a reason

BUYER'S GUIDE

Questions to ask before you choose a plastic surgery EHR

Ask every vendor, including us. The answers show whether a system was built for plastic surgery work or only adapted to it.

Ask us on a demo

Can reconstructive and cosmetic work be kept separate in scheduling, notes and billing?
Can photos and measurements be attached to support medical necessity?
Are wound repairs billed by length and complexity from the note?
Can cosmetic quotes be recorded and collected before surgery?
Are burns coded by site, degree and extent?

QUESTIONS

Plastic Surgery practices ask us

Can XEHR handle both cosmetic and insurance cases?

Yes. Self-pay services and insurance claims are handled in the same system.

Can we store clinical photos securely?

Yes. Documents and images stay inside XEHR and are never publicly reachable.

Can XEHR handle cosmetic and reconstructive work in one practice?

Yes. Insurance-billed and self-pay procedures are kept separate in scheduling, documentation and billing.

Does XEHR help document medical necessity for reconstruction?

Yes. Photos, measurements and symptoms are attached to the record and used to prepare the approval request.

Does XEHR keep clinical photos secure?

Yes. Photos are stored with the patient record and every access is recorded.

Can XEHR record self-pay deposits?

Yes. Deposits and payments for cosmetic procedures are recorded separately from insurance claims.

How much does XEHR cost for a plastic surgery practice?

Pricing is published: $189 per provider per month for the Clinical plan, $449 per provider per month for the Practice Suite with billing, or 2.5% of collections for RCM as a Service. Month-to-month, with a BAA on every plan. See pricing.

How long does it take a plastic surgery practice to go live?

Small practices are usually live in 2 to 4 weeks, including setup, data migration and training. We agree the plan with you before you sign.

Related specialties

See all specialties

See XEHR set up for plastic surgery

A 30-minute walkthrough on a live test environment, with your specialty's templates and billing.

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