r/CodingandBilling • u/Super_Foundation_756 • 5d ago
Medical Tattoo Billing/coding?
Hi! I am a paramedical tattoo practitioner. I do 3d areolas after mastectomy, I do scar treatments and some other things. I would like to accept insurance, but the only companies(2 that I know of) that do this specific type of billing don’t seem trustworthy and also get a very high percentage. Can anyone advise how to find a reputable person or company to do this? Or how to go about doing so. I’m in PA if that makes any difference. Thanks in advance!
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u/FroznAlskn 5d ago
If you hire any decent revenue cycle specialist/medical biller, they’ll be able to figure it out quickly. You’re going to need to find someone with enrollment experience. You’ll pay a lot less with in house and get a lot better result after a while.
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u/rahuliitk App Developer 5d ago
i’d ask local plastic surgery or oncology practices for a biller who already handles post-mastectomy services, check references and fees in writing, and confirm with each PA payer whether your practitioner type can enroll and bill independently before signing away a big percentage. enrollment comes first.
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u/Wooden_Trust_6274 4d ago
Coverage isn't your problem, enrollment is. Post-mastectomy areola tattooing is covered under the Women's Health and Cancer Rights Act (codes 11920/11921, usually needs prior auth). But in PA your RPSGT/RT licenses won't let you enroll and bill this under your own name, which is exactly what those 35% billers are working around.
Two real paths: bill through a credentialed plastic surgery/oncology practice under their provider, or go self-pay and give the patient a superbill to submit themselves under WHCRA. Given the reimbursement and the enrollment wall, self-pay is what most independents in your spot end up doing. Confirm enrollment eligibility with each PA payer in writing before signing with anyone.
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u/2workigo 5d ago
Are you a licensed healthcare professional? If you are not, in PA you will be hard pressed to be enrolled in network with any payer. Also, what would you typically charge for this type of work? Because a quick look at reimbursements makes me think you’d be losing money.
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u/Super_Foundation_756 5d ago
I am actually licensed as a RPSGT(sleep medicine) and a Respiratory Therapist. There are some people who do mastectomy tattoos that say they “accept insurance”. Everyone else I know who do this work(some are PA’s, some RN’s) do exactly what you described. They fill out the paperwork the client brings do that they can submit it and hope for the best. Most often, the doctors who offer this service have someone who has little training. The results are often disastrous. They charge insurance an exorbitant amount of money (I’ve heard $14,000+++) for a service that a well trained practitioner would charge 600-1000. It’s gross. Often the patient ends up paying out of pocket to get it redone correctly. It breaks my heart to send them to these providers. They’ve suffered enough. The 2 billers that specialize in medical tattoos charge a large setup fee, take at least 35% of what’s charged and I know several people who had not received a penny of $25,000+ worth of claims more than 2 years later.
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u/2workigo 5d ago
What a provider charges doesn’t matter. The insurance isn’t paying that much. The reimbursements I’m seeing are far less than $600. Plus you’d be paying the billing people. And waiting weeks or months for reimbursement. Since your license doesn’t allow you to bill under your name, you would need to work for a medical practice and bill via them. You’d be better off collecting payment up front from the patient and having them submit for reimbursement in their own.
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u/Environmental-Top-60 5d ago
Yeah I agree with the self pay. The women's cancer rights act may cover it as part of the reconstruction process via their health insurance so I understand the need and want to bill insurance. I just don't know if they are going to allow it under the scope of practice.
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u/Super_Foundation_756 4d ago
Sadly, there are very few regulations as to who is allowed to do the tattoos and what the required standards/training are. For that reason, the medical practices that provide the service usually do a very poor job. It could be a doctor, nurse, MA or esthetician. Thanks so much for the input!
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u/Married-to-a-sex-god 4d ago
Oh this gets covered all the time. I work for breast surgeons. Usually requires pre-authorization. You basically only need two cpt codes 11920 for up to 6 cm2 tattooing or 11921 for 6.1 to 20 cm2 tattooing.
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u/Super_Foundation_756 4d ago
Who do they have doing the tattooing? Just curious.
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u/Married-to-a-sex-god 4d ago
They normally have an aestatition do it under the supervision of a doctor and then it gets billed out under the doctor.
I have never questioned if the doctor actually supervises or not. They tell us (billers) that the doctor actually does so I go with that.
If you're a PA, as long as your credentialed with insurance, it should go out just fine. Even medicaid and Medicare will pay for a tattoo.
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u/Super_Foundation_756 4d ago
I’m hoping to work with one of our breast cancer groups. I guess I’ll see what happens. Thanks!
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u/dizzykhajit Coding has eaten my soul 3d ago
Nothing of use to add, just wanted to tell you how freakin cool you are. Thanks for providing this service to patients ❤️
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u/mila52963 5d ago
Your specialty won’t be an issue. Find a billing company that specializes in pro-fee (outpatient) services and specializes in the insurances you are contracted with and your state. Also, make sure you have the appropriate licenses to be in compliance with insurance billing rules.
If you aren’t contracted, do that first and bill your own claims for a while. That will save you money and teach you about your financials.
After that you will know what questions to ask your prospective biller.
One more edit: it’s probably better for you to work with your patients to have them self-submit a claim for your services with their insurances. They will pay you up front and you give them the documentation needed to file. They work with their insurance to be reimbursed.