Dermatology Billing Software

Dermatology Cost Estimator for Florida Practices

DermEstimator comes preloaded with both Florida Medicare localities — so your front desk always uses the right fee schedule for your county.

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Florida Medicare Localities

Medicare reimbursement rates in Florida vary by locality. DermEstimator includes both localities and auto-detects the correct one based on your practice ZIP code.

Locality 18
Miami-Dade County
Higher reimbursement rates apply in Miami-Dade County. If your practice is located here, DermEstimator automatically applies Locality 18 rates.
Locality 99
Rest of Florida
The vast majority of Florida practices outside Miami-Dade use Locality 99. Covers all other Florida counties. DermEstimator defaults to this locality for non-Miami-Dade ZIP codes.

ZIP-based auto-detection: DermEstimator reads your practice's ZIP code and selects the correct locality automatically — no manual switching required.

Built for Florida Dermatology Practices

Everything your front desk needs to give patients accurate cost estimates — and stay NSA-compliant.

525+ Derm CPT Codes

Complete dermatology code set including Mohs add-ons, excisions, destructions, and office visit E&M codes.

Good Faith Estimate Docs

Generate NSA-compliant GFE documents in one click with all required language pre-filled and locked in.

Automatic MPPR

Multiple Procedure Payment Reduction is calculated automatically. Add-on codes like 17312 and 17314 display at the correct 100% rate.

Custom Insurance Plans

Add your contracted payer rates so estimates reflect what patients owe under their actual insurance — not just Medicare.

APP (Advanced Practice Provider) Billing

APP (Advanced Practice Provider) billing at 85% own NPI or 100% incident-to — per procedure. Mohs codes (17311–17315) locked to MD per CMS rules. Accurate estimates for every provider type in your Florida practice.

Florida Commercial Payer Reference

Florida dermatology practices bill across a wide range of commercial payers, each with distinct reimbursement profiles relative to the 2026 Medicare Physician Fee Schedule. Understanding these rate multiples helps front desk staff set accurate patient expectations and identify when a custom fee schedule upload in DermEstimator will meaningfully improve estimate accuracy.

Florida Blue (BCBS Florida)
Typically 115–130% of Medicare. Florida's largest commercial carrier by covered lives. Locality-specific fee schedules vary between South Florida and the rest of the state.
Aetna Florida
Typically 110–125% of Medicare. Strong presence in employer-sponsored plans across Tampa Bay, Orlando, and Miami metro markets.
UnitedHealthcare Florida
Typically 110–125% of Medicare. Significant Medicare Advantage market share in Florida retirement communities. Commercial and MA rates differ considerably.
Humana Florida
Typically 105–115% of Medicare for commercial plans. One of Florida's dominant Medicare Advantage carriers — Humana MA rates trend closer to Medicare than commercial contracts.
Cigna Florida
Typically 110–120% of Medicare. Primarily employer-sponsored plans concentrated in major metro areas. Upload your Cigna EOB data to DermEstimator for contract-accurate estimates.
WellCare (Medicare Advantage)
Variable — often at or near Medicare rates. Florida has one of the highest Medicare Advantage penetration rates in the US. DermEstimator's MA payer profiles cover WellCare out of the box.
Florida Medicaid MCOs
Sunshine Health, Simply Healthcare, Humana Healthy Horizons, Aetna Better Health, and Molina Healthcare — all managed care organizations operating at or below Medicare reimbursement for most dermatology CPT codes.

Rate multiples above are industry reference ranges. Your contracted rates may differ. Upload your actual fee schedules to DermEstimator for the most accurate patient cost estimator results at your practice.

Florida-Specific No Surprises Act Compliance Notes

Florida dermatology practices are subject to the federal No Surprises Act (NSA), which requires Good Faith Estimates for self-pay and uninsured patients scheduled more than three business days in advance. Florida follows federal NSA rules without an additional state-specific GFE statute layered on top.

Florida practices should also be aware of Florida Statute § 627.64194, the state's surprise billing protection law, which governs balance billing protections for insured patients in certain out-of-network situations. While § 627.64194 is separate from NSA GFE requirements, it reinforces the importance of accurate upfront cost disclosure — exactly what DermEstimator is built to provide.

DermEstimator's Good Faith Estimate generator is built to meet all federal NSA requirements including itemized procedure codes, expected charges, total estimated cost, provider identification, and the federally required patient dispute resolution notice (IDRE process, $400 threshold, 120-day filing window). Every GFE generated includes the required references to the patient's right to initiate a dispute.

Florida dermatology practices can generate a compliant Good Faith Estimate PDF in under 60 seconds — no separate templates, no manual PDF assembly, no compliance guesswork.

How Florida Dermatology Practices Use DermEstimator

From Mohs surgery centers in Tampa to multi-provider practices in Miami, here are three real-world scenarios where dermatology billing software like DermEstimator eliminates manual math and reduces patient billing surprises.

Tampa Mohs Surgeon: Same-Day Biopsy, Mohs, and Closure

A Tampa-area Mohs surgeon frequently performs a same-day biopsy (11102), first-stage Mohs (17311), and intermediate closure (12032) in a single visit. DermEstimator applies the multiple procedure rule automatically — 100% on the highest-allowable procedure, 50% on each subsequent procedure — and correctly identifies 17312 and 17314 as add-on codes that bypass MPPR entirely. The front desk generates an accurate patient cost estimate before the patient leaves the consult room, accounting for their UnitedHealthcare deductible and coinsurance in real time.

Miami Medical-Cosmetic Practice: Medicare + Commercial Locality Switching

A Miami practice billing both Medicare patients (Locality 03 — South Florida) and Aetna commercial patients needs accurate rates for both populations. DermEstimator auto-detects the South Florida Medicare locality from the practice ZIP code and applies the correct geographic adjustment factors. For Aetna patients, the practice has uploaded their fee schedule CSV — so estimates reflect actual contracted rates, not just Medicare multiples. Switching between patient types takes seconds, and the medical practice cost calculator handles both scenarios from the same interface.

Jacksonville Solo Dermatologist: Self-Pay Aesthetic and NSA GFE

A Jacksonville solo dermatologist offers both medical and self-pay cosmetic services. For self-pay medical patients, the practice is required to issue a Good Faith Estimate under the No Surprises Act. DermEstimator generates a fully NSA-compliant GFE PDF — with all required disclosures, itemized CPT codes, and the dispute resolution notice — in under a minute. For aesthetic patients with custom pricing, the practice uses DermEstimator's custom fee schedule feature to enter their own rates and generate consistent, professional estimates for every consult.

Orlando Multi-Provider Practice: APP Billing

An Orlando dermatology group employs two PAs who independently see patients for biopsies, actinic keratosis destructions, and excisions. DermEstimator lets the front desk toggle each procedure to APP billing — automatically applying the 85% Medicare rate when the APP bills under their own NPI, or 100% when billing incident-to the supervising MD. Mohs procedures (17311–17315) are locked to MD billing per CMS rules, so staff can't accidentally bill those under an APP. Each provider type gets accurate estimates without a separate tool or manual calculation.

Florida Dermatology Billing FAQ

Does Florida have additional Good Faith Estimate requirements beyond the federal No Surprises Act?

No. Florida follows federal NSA GFE requirements without an additional state-specific GFE mandate. However, Florida Statute § 627.64194 governs surprise billing protections for insured patients in out-of-network situations, reinforcing the importance of accurate upfront cost disclosure. DermEstimator's Good Faith Estimate generator meets all federal NSA requirements applicable to Florida dermatology practices.

How do Florida Medicare reimbursement rates differ between Miami-Dade and the rest of the state?

Florida has two Medicare Physician Fee Schedule localities. South Florida (Locality 03) covers Miami-Dade, Broward, and Palm Beach counties and carries slightly higher geographic adjustment factors (GAFs) reflecting higher local costs. The Rest of Florida locality applies statewide outside those three counties. DermEstimator automatically detects the correct locality from your practice ZIP code — no manual selection required.

Which Florida commercial payers does DermEstimator support out of the box?

DermEstimator includes payer profiles for Florida Blue (BCBS Florida), Aetna, UnitedHealthcare, Humana, Cigna, WellCare, and Florida Medicaid MCOs (Sunshine Health, Simply Healthcare, Humana Healthy Horizons, Aetna Better Health, Molina). For practices with negotiated contracts, a CSV fee schedule upload takes under five minutes and makes every estimate contract-accurate.

Can a Florida dermatology practice use DermEstimator for both medical and cosmetic patients?

Yes. DermEstimator handles both insurance-billed medical dermatology (with full deductible, copay, and coinsurance calculations) and self-pay cosmetic patients using custom rate entry. Good Faith Estimates can be generated for either patient type. The same CPT code database and estimator interface serves both without any configuration changes.

Is DermEstimator HIPAA-compliant for Florida practices?

DermEstimator is built with a HIPAA-aware architecture. Cost estimates and Good Faith Estimates are generated without requiring patient PHI — you enter procedure codes and insurance parameters, not patient names or dates of birth. Estimates are not stored against patient identifiers by default. See our HIPAA & Security page for full details.

What CPT codes does DermEstimator include for Florida Mohs surgeons?

DermEstimator includes the complete Mohs CPT set: 17311 (first stage, head/neck/hands/feet/genitalia), 17312 (additional stage, same area — add-on, excluded from MPPR), 17313 (first stage, trunk/arms/legs), 17314 (additional stage, trunk/arms/legs — add-on, excluded from MPPR), and 17315 (repair, add-on). All add-on codes are correctly calculated at 100% allowable, bypassing the multiple procedure rule that applies to primary codes.

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