One of the most common questions we hear is: “Why isn’t my dermatology visit considered preventive care like my annual physical with my primary care doctor?”

It’s a great question. Here’s what you need to know about why dermatologists can’t bill preventive visit codes—and what happens if we try.

Preventive Care Is for Primary Care

Insurance companies—including Medicare—have strict guidelines on what qualifies as preventive care. These visits, such as annual physicals and wellness exams, are designed to be performed by primary care providers (PCPs), such as family medicine or internal medicine doctors.

These visits are billed using specific preventive care codes that are often covered in full by insurance plans.

Dermatologists, on the other hand, are specialists. Our job is to diagnose and treat conditions related to your skin, hair, and nails. Because of this, dermatology visits are considered medical evaluations, not preventive care, even when the visit feels routine or is for a full-body skin check.

What Codes Do Dermatologists Use?

Since dermatologists aren’t considered primary care providers, we don’t use the same preventive billing codes. Instead, we use what's known as Evaluation and Management (E/M) codes—these are codes like 99203 or 99213.

These codes reflect:

• The reason for your visit
• What is evaluated or treated
• Any discussion, diagnosis, or follow-up planning

Even if you’re coming in for a “just-in-case” skin check, the visit still involves a detailed exam and medical decision-making. That’s why it’s billed using E/M codes, not preventive ones.

Why We Can’t Change the Code to Preventive

Sometimes patients ask if we can bill the visit as preventive to reduce their out-of-pocket cost. The answer is no—and here's why.

If we were to bill your visit using a preventive care code that doesn't apply to specialists, your insurance will likely deny the claim entirely. When that happens, the insurer won’t pay anything, and you could be responsible for the full cost of the visit out-of-pocket.

We’re required to use billing codes that accurately reflect the type of visit and the provider who is delivering care. Using the wrong code—even with good intentions—can lead to denied claims and unexpected bills.

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

Many patients tell us that they called their insurance company and were told something like, “Just ask your doctor to change the code to preventive and it will be covered.”

This is a common misunderstanding. Insurance representatives often aren’t trained in the specifics of medical coding. What they’re really saying is that codes can be changed in general—but they don’t usually understand that there are strict rules about which codes can be used by which providers.

Yes, codes are editable in a billing system when errors occur—but if we change a dermatology visit to a preventive care code, it will still be rejected because it doesn’t fit the guidelines for specialists. That leaves you responsible for the entire bill. So while the rep isn’t technically wrong that codes can be changed, they are often unaware of the consequences of doing so incorrectly.

What If I’m Just Getting a Skin Check?

We understand that it may feel like a preventive visit when you’re just getting a skin check. But because we are performing a medical evaluation—often looking for and addressing early signs of conditions like skin cancer—your insurance considers it a medical visit.

That’s why it’s not coded or billed the same way as an annual physical with your PCP.

Questions About Your Coverage?

Every insurance plan is different. If you have questions about how your visit was billed or what your plan covers, we encourage you to reach out to your insurance company, or contact our office and we’ll help clarify anything we can.

Our priority is always to provide the best care while keeping billing transparent and aligned with insurance rules.