Plastic and reconstructive surgery billing remains one of the most complex areas of medical coding and reimbursement in the United States. As we move into 2025, insurers including Medicare, Blue Cross Blue Shield (BCBS), and Aetna continue to tighten coverage rules around medical necessity, cosmetic exclusions, and documentation sufficiency. Even highly skilled surgeons face revenue loss when CPT codes are not supported by proper clinical justification and ICD-10 pairing.
This in-depth guide on Common Plastic & Reconstructive Surgery CPT Codes is written specifically as a solution for U.S. healthcare providers, plastic surgeons, billers, and revenue cycle managers. Each section explains how to use CPT codes correctly, why claims are denied, and how to meet payer expectations helping practices reduce denials, improve compliance, and maximize legitimate reimbursement.
Cosmetic vs Reconstructive Surgery
One of the most common reasons plastic surgery claims are denied in the U.S. is failure to clearly distinguish cosmetic intent from reconstructive necessity.
From an insurance perspective:
- Cosmetic surgery improves appearance only → generally non-covered
- Reconstructive surgery restores function or corrects abnormalities → potentially reimbursable
Provider Solution
Every operative report and clinical note must clearly answer:
What functional problem does this procedure treat?
When clinical documentation focuses only on appearance, insurers automatically deny claims even if the procedure required advanced surgical skill. Clear documentation of functional impairment, disease-related pathology, trauma, or cancer-related defects is the foundation of successful plastic surgery medical billing and reimbursement.
Integumentary System CPT Codes (Skin, Flaps & Soft Tissue Repair)
CPT 14000–14302: Adjacent Tissue Transfer or Rearrangement
Clinical Use
These codes describe local tissue movement techniques such as rotation flaps, advancement flaps, Z-plasty, and W-plasty. They are commonly used after:
- Skin cancer excision
- Traumatic wounds
- Non-healing or complex defects
Why Claims Are Denied
Insurers deny these codes when documentation fails to show why simple closure was not sufficient.
Provider Solution
To support reimbursement:
- Document the exact defect size in square centimeters
- Identify the anatomic location
- Explain why primary closure would compromise healing or function
- Link the procedure to ICD-10 diagnoses such as skin cancer or trauma
When documented correctly, these CPT codes are widely covered by Medicare and commercial payers.
CPT 15570–15738: Muscle, Myocutaneous & Fasciocutaneous Flaps
Clinical Use
These codes describe complex vascularized tissue transfers, often required in:
- Head and neck reconstruction
- Breast reconstruction
- Large trunk or extremity defects
Denial Risk
Payers often downcode flap procedures, claiming that a simpler tissue transfer would have sufficed.
Provider Solution
Operative notes must clearly document:
- Vascular requirements of the defect
- Risk of tissue necrosis without flap coverage
- Functional or structural consequences if reconstruction is delayed
Clear surgical rationale protects reimbursement and prevents downcoding.
CPT 15771–15774: Autologous Fat Grafting
Clinical Use
Fat grafting may be reimbursable when used to:
- Correct contour defects after cancer surgery
- Restore volume after trauma
- Improve outcomes of prior reconstructive procedures
Common Denial Reason
Automatically classified as cosmetic.
Provider Solution
Never document fat grafting as “volume enhancement.” Instead, link it to:
- Structural deformity
- Post-surgical contour irregularities
- Reconstructive ICD-10 diagnoses
CPT 15830: Lower Abdominal Panniculectomy
Clinical Use
This code applies only to medically necessary panniculectomy, not cosmetic abdominoplasty. Covered indications include:
- Chronic intertrigo or infections
- Ulceration
- Functional impairment after massive weight loss
Provider Solution
Most U.S. payers require:
- Photographic evidence
- Failed conservative treatment documentation
- Symptoms lasting 3–6 months or longer
Failure to meet these criteria leads to near-automatic denial.
Breast Surgery CPT Codes
CPT 19316: Mastopexy
Coverage Reality
Often denied when performed for appearance alone.
Provider Solution
This code may be reimbursed when used for:
- Post-mastectomy reconstruction
- Correction of asymmetry after cancer treatment
Always pair with reconstructive ICD-10 codes.
CPT 19318: Reduction Mammaplasty
Covered Indications
- Chronic neck, back, or shoulder pain
- Shoulder grooving
- Recurrent rashes or infections
- Functional limitations
Denial Prevention Strategy
Document:
- Symptom duration
- Failed conservative therapy (physical therapy, pain management)
- Estimated tissue removal per breast
CPT 19325: Breast Augmentation with Implant
Billing Reality
Cosmetic augmentation is not covered.
Provider Solution
Covered only when used for:
- Post-mastectomy reconstruction
- Congenital breast deformities
Diagnosis selection determines reimbursement.
CPT 19340–19369: Breast Reconstruction Procedures
Under U.S. federal law, insurers must cover post-mastectomy breast reconstruction.
Provider Solution
Documentation should clearly state:
- Immediate vs delayed reconstruction
- Type of prosthesis or flap
- Cancer history or mastectomy status
CPT 19370–19380: Revision of Reconstructed Breast
Common Denial Reason
Labeled cosmetic refinement.
Provider Solution
Tie revisions to:
- Implant complications
- Pain or discomfort
- Functional asymmetry or deformity
Head, Face & Nasal Reconstruction CPT Codes
CPT 21120–21296: Oral & Maxillofacial Reconstruction
Clinical Use
- Trauma repair
- Tumor-related defects
- Congenital abnormalities
Provider Solution
Document how the defect affects:
- Speech
- Chewing
- Airway or facial structure
CPT 30400–30520: Rhinoplasty & Nasal Reconstruction
High-Denial Category
Provider Solution
Coverage requires:
- Documented nasal obstruction
- Failed medical management
- Structural abnormality affecting breathing
Avoid cosmetic language entirely.
CPT 67904: Ptosis Repair
Coverage Requirements
- Visual field testing
- Photographic documentation
- Functional impairment affecting daily activities
Common Cosmetic CPT Codes (Typically Non-Covered)
- 15822–15823: Blepharoplasty
- 15828–15829: Rhytidectomy
- 15847: Abdominoplasty
- 15877: Liposuction
- 11950–11954: Dermal fillers
Provider Reality
These procedures are generally self-pay unless clear reconstructive necessity is proven.
ICD-10 + CPT Pairing Tables (Denial-Reduction Tool)
Rhinoplasty & Nasal Reconstruction
| CPT | Procedure | ICD-10 Examples |
| 30400 | Nasal tip rhinoplasty | J34.2, M95.0 |
| 30420 | Septoplasty | J34.2 |
| 30465 | Nasal valve repair | J34.89 |
Breast Surgery
| CPT | Procedure | ICD-10 Examples |
| 19318 | Breast reduction | N62, M54.9 |
| 19340 | Breast reconstruction | Z42.1 |
| 19370 | Reconstruction revision | T85.49XA |
Skin & Flaps
| CPT | Procedure | ICD-10 Examples |
| 14000–14302 | Adjacent tissue transfer | C44.xxx |
| 15570–15738 | Flap procedures | Z48.3 |
| 15830 | Panniculectomy | L30.4 |
Common Plastic & Reconstructive Surgery CPT Codes (2026)
| Procedure | CPT Code(s) | Coverage Status (Typical) | Key Billing Notes |
|---|---|---|---|
| Neck Lift / Cervicofacial Rhytidectomy | 15824, 15828 | ❌ Cosmetic (Usually Non-Covered) | Covered only when tied to trauma, cancer reconstruction, or functional impairment |
| Brow Lift (Brow Ptosis Repair) | 67900 | ⚠️ Conditionally Covered | Requires visual field testing, photos, and functional impairment |
| Platysmaplasty | 15824 (Bundled) | ❌ Cosmetic | No standalone CPT; bundled into neck rhytidectomy |
| Bullhorn Lip Lift | No CPT Code | ❌ Non-Covered | Always self-pay; do not submit to insurance |
| Liposuction | 15876, 15877 | ❌ Cosmetic (Most Cases) | Covered only for disease-related conditions (e.g., lipedema) |
| Lower Blepharoplasty | 15820, 15821 | ❌ Cosmetic (Usually) | Coverage only with documented functional eye impairment |
| Cervicoplasty | 15824 (Bundled) | ❌ Cosmetic | Included in neck lift coding; not separately billable |
| Brachioplasty (Arm Lift) | 15836 | ⚠️ Conditionally Covered | Must show chronic infection, skin breakdown, or functional limitation |
Payer Coverage Comparison (USA – 2025)
Medicare
✔ Covers reconstructive surgery only
✔ Requires medical necessity and failed conservative therapy
✖ Does not cover cosmetic procedures
BCBS
✔ Covers reconstruction with strict criteria
⚠ Often requires prior authorization and photos
Aetna
✔ Covers reconstruction per clinical policy bulletins
❌ Denies aggressively without detailed documentation
Essential CPT Modifiers (Revenue Protection)
| Modifier | Purpose |
| -22 | Increased complexity |
| -50 | Bilateral procedures |
| -51 | Multiple procedures |
| -59 | Distinct procedural services |
Denial-Proof Documentation Checklist (2025)
Pre-Operative
✔ Confirm reconstructive intent
✔ Obtain prior authorization
✔ Capture imaging and photos
Clinical Notes
✔ Functional impairment description
✔ Symptom duration
✔ Failed conservative treatment
Coding & Billing
✔ Accurate CPT + ICD-10 pairing
✔ Correct modifier use
✔ Payer policy review
Conculsion
Plastic and reconstructive surgery coding requires far more than selecting the correct CPT code. Reimbursement success depends on documentation depth, diagnosis accuracy, payer compliance, and billing expertise.Practices that struggle with denials often benefit from outsourcing plastic surgery billing services to specialized teams that understand payer rules, audit risks, and appeal strategies.
When providers control the medical necessity narrative, plastic and reconstructive surgery becomes one of the most sustainable and profitable specialties, even in an era of aggressive payer audits.
