What Dermatology Procedures Are Covered by Insurance? A Complete Guide

Navigating insurance coverage for dermatology services can be confusing. While many people assume all visits to the dermatologist come with high out-of-pocket costs, the truth is that numerous medically necessary dermatology procedures are covered by insurance plans. Understanding which treatments qualify for coverage can help you get the care you need without unexpected expenses.

Understanding Medical vs. Cosmetic Dermatology

The key distinction that determines insurance coverage is whether a procedure is considered medically necessary or cosmetic. Insurance companies typically cover treatments that diagnose, prevent, or treat medical conditions, while cosmetic procedures aimed solely at improving appearance are generally not covered.

What Does "Medically Necessary" Mean?

A procedure is considered medically necessary when it's required to:

• Diagnose or treat a disease or medical condition

• Prevent a condition from worsening

• Alleviate symptoms that interfere with daily functioning

• Address pain or discomfort caused by a skin condition
  

Dermatology Procedures Typically Covered by Insurance

1. Skin Cancer Screenings and Treatment

Skin cancer detection and treatment are among the most commonly covered dermatology services. This includes:

• Annual full-body skin examinations for high-risk patients

• Biopsies of suspicious lesions

• Surgical removal of skin cancers (basal cell carcinoma, squamous cell carcinoma, melanoma)

• Mohs surgery for specific skin cancer cases

• Follow-up care and monitoring

2. Acne Treatment

Moderate to severe acne is recognized as a medical condition requiring treatment. Covered services often include:

• Office visits for acne evaluation and management

• Prescription medications (oral and topical)

• Steroid injections for cystic acne

• Extraction of comedones when medically necessary

3. Eczema and Psoriasis Management

Chronic inflammatory skin conditions typically qualify for insurance coverage:

• Diagnosis and ongoing treatment of eczema (atopic dermatitis)

• Psoriasis treatment and management

• Prescription topical medications

• Phototherapy (light therapy) for severe cases

• Biologic medications when other treatments have failed

4. Rashes and Allergic Reactions

Evaluation and treatment of various skin conditions including:

• Contact dermatitis

• Hives (urticaria)

• Drug reactions

• Patch testing for allergies

5. Infections

Treatment of skin infections is generally covered:

• Bacterial infections (cellulitis, impetigo, folliculitis)

• Fungal infections (ringworm, nail fungus)

• Viral infections (shingles, warts)

6. Mole Removal and Lesion Excision

When performed for medical reasons:

• Removal of atypical or changing moles

• Excision of precancerous lesions (actinic keratoses)

• Biopsy of suspicious growths

• Removal of painful or irritated skin tags or cysts

7. Hair and Nail Disorders

Certain conditions affecting hair and nails may be covered:

• Alopecia (hair loss) evaluation and treatment

• Nail infections or disorders

• Scalp conditions (seborrheic dermatitis, psoriasis)

8. Surgical Procedures

Medical dermatology surgery is typically covered when medically necessary:

• Cyst removal (when infected or painful)

• Abscess drainage

• Keloid treatment

• Scar revision (when scars limit function or cause pain)

Procedures Usually NOT Covered by Insurance

It's important to understand that cosmetic procedures are rarely covered by insurance:

• Botox

• Dermal fillers

• Chemical peels

• Microdermabrasion

• Laser hair removal

• Cosmetic laser treatments

• Anti-aging treatments

• Tattoo removal

• Spider vein treatment

Medicare Coverage for Dermatology

Medicare beneficiaries should know that Original Medicare (Parts A and B) typically covers medically necessary dermatology services, including:

• Skin cancer screenings and treatment

• Treatment of skin conditions and diseases

• Diagnostic tests and biopsies

However, Medicare does not cover routine skin exams or cosmetic procedures.

Tips for Maximizing Your Insurance Coverage

1. Verify Coverage Before Your Appointment

Always check with your insurance provider about your specific plan's coverage for dermatology services. Ask about:

• Whether you need a referral from your primary care physician

• In-network dermatologists in your area

• Your copay, coinsurance, and deductible requirements

2. Get Proper Documentation

Your dermatologist should document the medical necessity of any procedure. This includes:

• Detailed notes about symptoms

• Photographs of conditions

• Failed treatment attempts

• How the condition affects your quality of life

3. Understand Pre-Authorization Requirements

Some procedures may require pre-authorization from your insurance company. Common examples include:

• Biologic medications

• Phototherapy

• Certain surgical procedures

4. Ask About Diagnostic Codes

Procedures are billed using specific diagnostic codes (ICD-10) and procedure codes (CPT). Understanding these codes can help you verify coverage with your insurance company.

5. Appeal Denied Claims

If a medically necessary procedure is denied, you have the right to appeal. Work with your dermatologist's office to provide additional documentation supporting the medical necessity.

Out-of-Pocket Costs to Expect

Even with insurance coverage, you may be responsible for:

• Copays: A fixed amount per visit

• Deductible: The amount you pay before insurance kicks in

• Coinsurance: A percentage of the treatment cost

• Out-of-network fees: Higher costs if your dermatologist isn't in your insurance network

Questions to Ask Your Dermatology Provider’s Office

Before your appointment, contact the office to inquire about:

1. Which insurance plans do you accept?

2. Do you accept Medicare and commercial insurance?

3. Will I need a referral from my primary care doctor?

4. What are the estimated costs for my specific procedure?

5. Do you offer payment plans for out-of-pocket expenses?

My Skin: Your Insurance-Friendly Dermatology Partner

At My Skin, we understand how important accessible dermatology care is to our patients in St. Petersburg and Bradenton, Florida. That's why we accept insurances such as:

• Medicare

• Tricare

• Aetna

• Oscar

• Cigna

• Blue Cross Blue Shield

• United

• Humana

• Devoted

• Curative

• And self-pay for medical and surgical dermatology services.

Founded by Leah Michel, APRN FNP-BC, our practice is dedicated to delivering personalized dermatology care with 30-minute appointments that allow time to truly listen, evaluate, and create customized treatment plans. Whether you're dealing with acne, skin cancer concerns, eczema, or other skin conditions, we're here to help you achieve healthy, clear skin.

Why Choose My Skin?

• Insurance-friendly: We work with Medicare and most commercial insurance plans

• Comprehensive care: From medical dermatology to surgical procedures

• Experienced provider: Led by a board-certified nurse practitioner specializing in dermatology

• Personalized attention: Longer appointment times mean better care

• Two convenient locations: St. Petersburg and Bradenton

Our procedures are minimally invasive and use advanced techniques to minimize the risk of recurrence with minimal scarring. We're committed to helping you get your life back on track with clear and healthy skin.

Schedule Your Appointment Today

Don't let insurance questions prevent you from getting the dermatology care you need. Our knowledgeable team at My Skin can help you understand your coverage and work with your insurance provider to maximize your benefits.

Contact us today:

St. Petersburg Office
111 2nd Ave NE, Suite 1406
St Petersburg, FL 33701
Phone: (727) 295-7223

Bradenton Office
4301 32nd St. W., Suite D2
Bradenton, FL 34277
Phone: (941) 330-5805

Frequently Asked Questions

Do I need a referral to see a dermatologist?
This depends on your insurance plan. Some plans require a referral from your primary care physician, while others allow direct access to specialists. Check with your insurance provider or contact our office for assistance.

How much will my visit cost?
Costs vary based on your insurance plan, deductible status, and the specific services provided. We recommend calling your insurance company before your appointment to understand your out-of-pocket responsibility.

Do you offer self-pay options?
Yes, we accept self-pay patients and can discuss payment options during your visit.

Conclusion

Understanding which dermatology procedures are covered by insurance empowers you to seek the care you need with confidence. Most medically necessary treatments including skin cancer screenings, acne treatment, and management of chronic conditions like eczema and psoriasis are typically covered by insurance plans.

At My Skin, we're committed to making dermatology care accessible and affordable. By accepting Medicare and most commercial insurances, we ensure that our patients in St. Petersburg and Bradenton can receive high-quality, personalized dermatology care without unnecessary financial barriers.

Ready to take control of your skin health? Schedule your appointment with My Skin today and let us help you navigate your insurance coverage while achieving your healthiest, most beautiful skin.

This blog post is for informational purposes only and should not be considered medical or insurance advice. Coverage varies by insurance plan and individual circumstances. Please contact your insurance provider and our office to verify your specific coverage details.