Why Your Dermatology Visit Isn’t Considered Preventive Care
We often hear questions like:
“Why did I receive a bill? I only had my yearly skin exam, which my insurance says should be fully covered.”
“Why isn’t my skin check treated the same as my preventive physical with my primary care doctor?”
They’re excellent questions—and the confusion is completely understandable. Below is an explanation of why dermatologists can’t bill for preventive care visits, and what happens when those codes are used incorrectly.
Preventive Care Is for Primary Care Providers
Insurance companies, including Medicare, have very specific rules about what qualifies as preventive care. These visits—such as annual wellness exams and physicals—are intended for primary care providers (PCPs) like family medicine or internal medicine doctors.
Those appointments are billed using preventive care codes, which are often covered at 100% by insurance plans.
Dermatologists, however, are specialists. Our role is to evaluate, diagnose, and treat conditions involving your skin, hair, and nails. For that reason, dermatology visits are categorized as medical evaluations, not preventive care—even if your visit feels routine or is for a “skin check.”
How Dermatology Visits Are Billed
Because dermatologists aren’t considered PCPs, we don’t use preventive care codes. Instead, we bill using Evaluation and Management (E/M) codes—such as 99203 or 99213.
These codes are based on:
- The reason for your visit
- What was examined or treated
- The level of discussion, diagnosis, and follow-up involved
Even if you come in for a precautionary skin exam, we’re still conducting a detailed medical evaluation and making professional decisions about your care. That’s why it’s billed using E/M codes rather than preventive ones.
Why We Can’t “Change the Code”
Sometimes patients ask if their visit can be billed as preventive to lower their out-of-pocket cost. Unfortunately, that’s not allowed.
If a dermatology office submits a preventive care code that doesn’t apply to specialists, the insurance company will likely deny the entire claim. When that happens, the insurer pays nothing—and the full balance becomes your responsibility.
By law, we must use codes that accurately represent the service performed and the provider type. Using the wrong code, even with good intentions, can lead to denied claims or billing issues.
“But My Insurance Said You Could Just Change the Code…”
We hear this often. Many patients contact their insurance company and are told, “Just ask your doctor to change the code to preventive, and it will be covered.”
Unfortunately, this is a common misunderstanding. Insurance representatives aren’t typically trained in medical coding or aware of provider-specific billing rules. While codes can technically be corrected in a billing system, that doesn’t mean a specialist can reclassify a medical visit as preventive.
If we were to submit a preventive code for a dermatology visit, it would still be rejected because it doesn’t meet the insurer’s criteria for preventive care. That’s why changing the code isn’t a viable solution.
What About a Routine Skin Check?
It’s understandable to think of a skin check as a preventive visit. However, when a dermatologist examines your skin, we’re performing a medical evaluation—looking for signs of conditions such as skin cancer and discussing findings or next steps.
Because of that, your insurance company categorizes the visit as a medical service, not a preventive one.
Have Questions About Your Coverage?
Every insurance plan is a little different. If you’re unsure how your visit was billed or what your plan covers, we encourage you to contact your insurance provider—or reach out to our office. We’re happy to review your situation and help clarify any confusion.
Our goal is to provide exceptional care while keeping billing transparent and compliant with insurance guidelines.