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Superbill for plastic surgery 2026

The document is a guide for providers on how to complete the Elective Cosmetic Surgery Superbill, which includes CPT codes for elective cosmetic procedures within the Military Health System (MHS). It outlines the necessary information to be filled out by providers, such as patient details, procedure codes, and anesthesia options. The Superbill is used by MSA staff to generate cost estimates for patients. Additionally, it provides instructions for specific procedures, billing practices during global periods, and the standard process for scheduling and performing elective cosmetic surgeries.

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Click ‘Get Form’ to open the superbill in the editor.
In the header, enter the name of your MTF where the procedure will be performed, along with your full name and office phone number.
For ICD-9-CM Code 1, select a diagnosis code from the V50.X series that corresponds to the elective cosmetic procedure.
If applicable, enter a second ICD-9-CM code in the designated field.
Choose the location for the procedure: Provider’s Office or Operating Room—Outpatient.
Print the patient’s full name and enter consultation visit and surgery dates using MM/DD/YYYY format.
Select an anesthesia option from Topical, Local, Moderate Sedation, General/Monitored Anesthesia Care, or None.
Indicate if any elective procedures will be combined with medically necessary procedures during the same encounter.
Highlight or circle each selected procedure description and enter corresponding CPT® codes as needed.
Specify whether procedures are bilateral and indicate quantities required for each procedure in their respective fields.

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