Dermatology billing and revenue cycle for Texas providers.
Texas operates 659 dermatology provider organizations registered in NPPES, representing 7.4 percent of the U.S. dermatology billing footprint. Texas is a major dermatology billing market. Dermatology revenue cycle requires precision: lesion removal sizing, Mohs stage billing, cosmetic vs medical separation, modifier 25 discipline, and biologic PA management. Texas dermatology practices need RCM that handles this granularity reliably.
What good dermatology billing execution looks like for Texas providers.
The Texas dermatology billing market has its own quirks. Here is the operating discipline we install on every Texas engagement.
- Lesion removal coding by size and methodDermatology lesion removal billing requires precise capture of lesion size, anatomic location, benign vs malignant pathology, and removal method (excision, destruction, shave). Texas derm practices need coders who can read op notes accurately.
- Mohs surgery billing and stage trackingMohs micrographic surgery bills per stage with specific CPT codes (17311-17315). Accurate stage tracking and same-day reconstruction coding are essential.
- Cosmetic vs medical service separationTexas dermatology practices often mix cosmetic (cash pay) and medical (insurance) services. Clean separation in scheduling, billing, and patient consent prevents claim disputes and audit risk.
- Modifier 25 discipline for E/M + procedureSame-day E/M plus procedure (biopsy, destruction, injection) is daily reality in dermatology. Modifier 25 must be defensible with clear separate E/M documentation.
- Path lab billing for in-house specimensTexas dermatology practices with in-house pathology need accurate 88305 / 88312 billing, professional + technical component awareness, and CLIA compliance.
- Specialty drug PA for biologics (Dupixent, Cosentyx, etc.)Dermatologic biologics carry significant PA burden and specialty pharmacy coordination. PA automation reduces patient access delays significantly.
State rule map · Texas
Texas dermatology billing runs on a 95-day clock.
TMHP must receive fee-for-service claims within 95 days, and managed care plans use the same window.
Health and Human Services Commission (HHSC)
- Date of service.
- TMHP and managed care filing deadline.
- Outer limit. HHSC considers exceptions only inside it.
Private plans: SB 1264 bans surprise bills for emergency care and for care at in-network facilities when the patient had no choice, including labs and imaging ordered by an in-network doctor.
- 95-day filing date
- Phototherapy diagnosis on the covered list
- Prior authorization for peels and dermabrasion
- NDC crosswalk match
- Ordering NPI enrollment
FAQ: dermatology billing in Texas.
How many dermatology providers operate in Texas?
NPPES lists 659 dermatology provider organizations in Texas, representing 7.4% of the U.S. footprint. Top concentrations are in Houston (93), Dallas (54), San Antonio (49).
Does Texas Medicaid cover dermatology billing services?
Yes. Texas Medicaid covers dermatology billing services for eligible beneficiaries, with plan-specific authorization rules and rate structures that vary by year.
What commercial payers cover dermatology billing in Texas?
All major national commercial payers cover dermatology billing in Texas, including UnitedHealthcare/Optum, Aetna, Cigna/Evernorth, the dominant Texas Blue Cross Blue Shield plan, and (where active) Humana.
Does ASP-RCM serve dermatology providers in Texas?
Yes. ASP-RCM Solutions provides dermatology billing and revenue cycle services for providers in Texas and across all 50 states. Senior partners on every account. Request a free RCM audit.
How do I get started?
Request a free RCM audit. We assess your current state, identify revenue leakage, and produce a written prioritized recommendations list.