Prior authorization for aesthetics practices
Payers generally cover reconstructive or functional procedures, not purely cosmetic ones, so the documentation has to show the functional impact precisely. Genkō Prior Auth asks for that up front and drafts a packet your team reviews and submits.
Updated · Markdown version
Framing comes first
Each request starts by choosing how the case is framed: functional or cosmetic. A functional framing requires you to describe the impairment (for example visual field loss or nasal obstruction); a cosmetic framing does not, and Prior Auth makes clear that cosmetic procedures are typically excluded from coverage. Whether a given procedure is covered is the payer's decision.
What it collects
| Field | Purpose |
|---|---|
| Framing | Functional or cosmetic. |
| Chief complaint | The patient's problem in a sentence or two. |
| Functional impairment | Required unless cosmetic: what the condition prevents or impairs, and how it is documented. |
| Measurements | For example margin-reflex distance, visual field degrees, septal deviation or tissue weight. |
| Photos taken | Which standardized clinical photographs support the assessment. |
| Prior treatment tried | What was tried first and why it was not enough. |
Procedure areas
Procedure codes (CPT and HCPCS) are searched from a curated list covering eyelids and brow, nose and ear, breast, body contouring, and scars, skin and lesions. Diagnoses use an ICD-10-CM search, and you can type a code that is not listed.
The packet
- A clinical justification that leads with the functional findings and measurements you recorded.
- A supporting-documentation summary, including the photographs you noted.
- A request letter, and a list of what the payer may expect that is missing.
Where things stand
Early access, by invitation, on synthetic data only. No real patient information should be entered, and no HIPAA compliance claim is made. Request early access, or see Getting started.