Who we serve · Dermatology
Dermatology practices. Medical work billed as medical, and paid.
For an independent dermatology practice, HRI Med offers billing, denials and payer enrollment, with the payer follow-up HRI built in behavioral-health billing. We enroll the practice and every dermatologist, physician assistant and nurse practitioner with each payer. Then we build each claim to hold up when a payer reads it.
Medical or cosmetic, and the note that proves it.
Medicare excludes cosmetic surgery by regulation. The exceptions are the prompt repair of an accidental injury and improving the function of a malformed body part.A A benign lesion can sit on either side. Medicare contractors cover its removal when the lesion is symptomatic, has changed, is inflamed, or when the diagnosis is uncertain, and they treat removal for appearance as cosmetic.B The note has to say which.
A visit on the day of a minor procedure, such as a biopsy, is usually part of the procedure's payment. Medicare pays it separately only when the record shows a significant, separately identifiable evaluation, billed with modifier 25, and it lets its contractors add prepayment review for a practice that uses the modifier far more than its peers.C
Mohs surgery is billed under CPT 17311 to 17315. The Medicare policy we read requires one physician to do both the excision and the reading of the slides, and the operative note must record each lesion's location and size, the stages, the specimens per stage, and why standard excision would not do.D
Then there are the physician assistants and nurse practitioners. Billing their visit under the physician's name as incident-to requires that the physician started the course of treatment and was in the office suite.E A PA seeing a new problem generally bills under their own enrollment, so every PA and NP needs one with every payer.
Biologics for eczema and psoriasis need approvals of their own. One national plan asks how much skin is involved, which topical treatments failed, and who prescribed, then wants the approval renewed.F
Every clinician enrolled, every claim read before it leaves.
- Enrollment
- The practice and every dermatologist, PA and NP, with Medicare, your state's Medicaid plans and each commercial plan you name. Each one followed to an effective date.
- The claim before it goes
- Medical or cosmetic, the same-day modifier, the Mohs note: checked while the fix is still a sentence in the chart.
- Drug approvals
- Biologic requests filed against the plan's criteria, and renewals tracked before they lapse.
- Payments and denials
- Posted against what each plan owes, short payments caught, every denial traced and appealed where the practice is owed.
| Piece of work | Fee |
|---|---|
| The practice, with each payer | $350 |
| Each dermatologist, PA or NP, with each payer | $250 |
| A clinician's CAQH ProView profile (CAQH now operates as DataSpring), built or repaired | $150 |
| A written answer on whether payers cover one service you are adding | $2,500 |
| Billing and the revenue cycle | By agreement |
Total your own enrollment with the calculator.
Common questions from dermatology practices.
Do you bill cosmetic procedures?
No. Cosmetic work stays self-pay, priced by you. We bill the medical work and help the note show which kind of visit it was.
A new physician assistant starts soon. What does enrollment cost?
With the practice already on file, each payer takes one practitioner application at $250, plus $150 if the CAQH profile needs building. We start with the plans most of your patients carry.
We are adding a service. Will our payers pay for it?
We answer that in writing for $2,500 per service: which of your payers cover it, under what codes and conditions, and what the chart must show. How the answer works
Sources
- Code of Federal Regulations, 42 CFR 411.15(h), cosmetic surgery exclusion. govinfo.gov. 2025 edition, read 2026.
- Medicare coverage policy L34938, Removal of Benign Skin Lesions (Novitas). cms.gov. Read 2026.
- Medicare Claims Processing Manual, chapter 12, sections 30.6.6 and 40.1. cms.gov. Read 2026.
- Medicare coverage policy L35494 and article A57477, Mohs Micrographic Surgery (WPS). cms.gov. Read 2026.
- Medicare Benefit Policy Manual, chapter 15, section 60.2. cms.gov. Read 2026.
- Aetna specialty pharmacy policy for dupilumab in atopic dermatitis. aetna.com. Other plans set their own criteria. Read 2026.
Send us your clinicians and your payer list.
We set your enrollment against the plans your patients carry and show you the gaps. No patient information needed.
Count physician assistants and nurse practitioners in the list as well as physicians.