# Prior authorization for aesthetics practices

Source: https://priorauth.getgenko.com/specialties/aesthetics · Updated 2026-10-18

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.

## 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.

> Prior Auth drafts only from what you record. It does not decide whether a procedure is cosmetic or reconstructive, and it cannot guarantee an approval.

## 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](https://priorauth.getgenko.com/early-access), or see [Getting started](https://priorauth.getgenko.com/docs/getting-started).

## Related

- [Appealing a prior authorization denial](https://priorauth.getgenko.com/guides/appealing-a-prior-authorization-denial)
- [What goes in a prior authorization packet](https://priorauth.getgenko.com/guides/prior-authorization-packet-checklist)
- [Prior authorization for dental practices](https://priorauth.getgenko.com/specialties/dental)