Why Dermatology Visits Aren’t Billed as Preventive Care

AJ Sammons
24 minutes ago
2 min read

Many patients ask us two common questions:

“Why did I get a bill when I only came in for my yearly skin check? My insurance says preventive care is covered 100%.”
“Why doesn’t my skin check count as preventive care, like my physical with my primary care doctor?”

These are understandable questions. Here is why dermatology visits are billed differently and why we can’t use preventive visit codes.

Preventive Care Is Limited to Primary Care

Insurance companies, including Medicare, define “preventive care” very specifically. Preventive visits are annual wellness or physical exams done by primary care providers (family medicine, pediatrics, internal medicine, etc.).

These visits use certain preventive billing codes that are usually covered at no cost to the patient.

Dermatologists, however, are considered specialists. Our role is to evaluate, diagnose, and treat conditions of the skin, hair, and nails. Even if your appointment feels routine—such as a full-body skin exam—it still counts as a medical evaluation, not a preventive check-up.

What Billing Codes Do Dermatologists Use?

Instead of preventive codes, dermatologists must use Evaluation & Management (E/M) codes like 99203 or 99213.

These codes reflect:

Why you came in
What was examined
Any diagnoses, discussions, or follow-up planning

Even a simple skin exam involves careful evaluation and medical decision-making, so E/M codes are required.

Why We Can’t Switch the Code

Patients sometimes ask us to bill a skin check as preventive to avoid out-of-pocket costs. Unfortunately, that is not allowed by insurance companies.

If we submitted your visit under a preventive code, your insurance would likely deny the claim entirely, leaving you responsible for the full balance.

By law and by insurance policies, we must use billing codes that correctly describe the visit and the provider type. Using the wrong code—intentionally or not—causes rejections and larger bills for patients.

“But My Insurance Said You Could Just Change the Code…”

We often hear that insurance representatives have told patients to “just ask your doctor to change the code.”

The unfortunate truth is that while billing systems can edit codes for legitimate errors, specialists cannot use preventive codes. Insurance call-center reps often don’t understand the strict rules around coding.

So even if a code is changed, if it doesn’t match the provider or visit type, the insurer will reject it and you could end up paying more.

What About Routine Skin Checks?

We know a skin check feels similar to preventive care, but insurance treats it as a medical visit. That’s because dermatologists are evaluating you for medical conditions—such as early signs of skin cancer—not just doing a general wellness exam.