Dermatology Billing Software

Dermatology Cost Estimator for New York Practices

New York includes Manhattan — home to the highest Medicare locality rates in the United States. DermEstimator comes preloaded with all five New York localities so your estimates are always precise.

Start Free Trial

New York Medicare Localities

New York uses five Medicare localities, spanning from the highest-paying locality in the country to broader upstate rates. DermEstimator auto-selects the correct one based on your practice ZIP code.

Highest rates in the US
Locality 01
Manhattan
Manhattan carries the highest Medicare locality rates in the entire United States. Getting these rates right is critical for any NYC dermatology practice — DermEstimator applies them automatically.
Locality 02
NYC Suburbs / Long Island
Covers Bronx, Kings (Brooklyn), Nassau, Richmond (Staten Island), Rockland, Suffolk, and Westchester counties — second-highest Medicare rates in New York.
Locality 99
Rest of New York
Covers all New York counties not assigned to other localities — including Buffalo, Rochester, Syracuse, Albany, and upstate practices.
Locality 03
Poughkeepsie / N. NYC Suburbs
Covers Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, and Ulster counties — Hudson Valley and the northern suburban ring.
Locality 04
Queens
Queens has its own dedicated Medicare locality — separate from the broader NYC Suburbs/Long Island locality — reflecting the borough's distinct cost structure.

ZIP-based auto-detection: DermEstimator reads your practice's ZIP code and selects the correct New York locality automatically — Manhattan practices get Locality 01 rates without any manual configuration.

Built for New York 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 display at the correct rate — no manual lookups.

Custom Insurance Plans

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

New York Commercial Payer Reference

New York dermatology practices bill across one of the most complex commercial payer landscapes in the country. Rate multiples relative to the 2026 Medicare Physician Fee Schedule vary substantially between downstate metro carriers and upstate regional plans. Understanding these ranges helps front desk staff set accurate patient expectations — and tells you exactly when uploading your negotiated fee schedule to DermEstimator will meaningfully close the gap between Medicare-based estimates and your actual contracted rates.

Empire BlueCross BlueShield (Anthem)
Typically 115–130% of Medicare. Dominant downstate commercial carrier. Rates vary considerably between the NYC metro market and upstate networks. Empire BCBS is the most common commercial payer for Manhattan and Long Island dermatology practices.
Excellus BlueCross BlueShield
Typically 110–125% of Medicare. The dominant commercial carrier for upstate New York — Buffalo, Rochester, Syracuse, and the surrounding regions. If your practice is in Western or Central NY, Excellus is likely your highest-volume commercial payer.
Aetna New York
Typically 110–125% of Medicare. Strong employer-sponsored plan presence across the NYC metro and mid-Hudson Valley. Aetna's Medicare Advantage and commercial rates differ — upload both fee schedules for full accuracy.
UnitedHealthcare New York
Typically 110–125% of Medicare. Significant employer-plan market share across the metro. UHC Medicare Advantage plans are also common in New York's senior population — rates diverge significantly from commercial contracts.
Cigna
Typically 110–120% of Medicare. Primarily employer-sponsored plans concentrated in the NYC metro and suburban markets. Upload your Cigna EOB data to DermEstimator for contract-accurate patient estimates.
Healthfirst
Variable — often at or near Medicaid rates. One of New York's largest Medicaid managed care organizations, with significant Medicare Advantage enrollment as well. Primarily serves the NYC five boroughs. Commercial and government program rates differ substantially.
Fidelis Care / MetroPlusHealth
Medicaid managed care rates — at or below Medicare for most dermatology CPT codes. Fidelis (Centene) operates statewide; MetroPlusHealth is NYC-specific. DermEstimator's Medicaid payer profiles allow you to enter these rates and generate accurate estimates for Medicaid patients.

Rate multiples above are industry reference ranges based on published payer data and CMS benchmarks. Your contracted rates may differ. Upload your actual fee schedules to DermEstimator for the most accurate patient cost estimates at your practice.

New York Surprise Billing Compliance Notes

New York dermatology practices operate under a dual compliance framework: the federal No Surprises Act (NSA), which governs Good Faith Estimates for self-pay and uninsured patients, and New York's own state-level surprise billing and disclosure laws, which impose additional requirements on top of federal rules.

New York Public Health Law § 24 requires health care professionals and group practices to disclose, upon patient request, the estimated charges for anticipated services. This state requirement predates the federal NSA and operates independently of it. Practices must be prepared to provide cost estimates verbally at scheduling and in writing upon request. The NSA's GFE requirement adds a parallel federal obligation for self-pay patients scheduled three or more business days in advance.

New York Financial Services Law Article 6, together with Insurance Law § 3241 and related regulations, governs balance billing protections for insured patients in out-of-network situations. New York's protections are broader in certain respects than the federal NSA — for example, New York's surprise bill rules apply to fully-insured plans and include stronger patient consent requirements for out-of-network services at in-network facilities.

DermEstimator's Good Faith Estimate generator meets all federal NSA requirements: itemized CPT codes, expected charges per service, total estimated cost, provider identification, and the required IDRE dispute notice (the $400 threshold, 120-day filing window). For New York practices with additional state-level disclosure obligations under PHL § 24, DermEstimator's on-demand estimate generation covers both: the front desk can generate a written estimate at any point during the scheduling process, not just for self-pay patients.

New York dermatology practices can produce a compliant estimate — state and federal — in under 60 seconds. No separate templates, no manual PDF assembly, no compliance guesswork.

How New York Dermatology Practices Use DermEstimator

From Manhattan concierge dermatology practices to Queens community health clinics, here are three real-world scenarios where DermEstimator eliminates manual math and reduces patient billing surprises across New York's varied payer landscape.

Manhattan Cosmetic-Medical Practice: Empire BCBS PPO and Self-Pay Aesthetics

A Manhattan dermatology practice sees both Empire BCBS PPO patients for medical dermatology and self-pay patients for aesthetic procedures. For the commercial patients, DermEstimator automatically applies the highest Medicare locality rates in the country (Locality 01) and layers the practice's Empire BCBS contracted fee schedule on top for accurate cost-share calculations. For self-pay aesthetic patients, the practice enters its own cosmetic pricing, generates a professional estimate, and — when required under New York PHL § 24 — delivers a written cost disclosure in under a minute. The front desk handles both patient types from the same interface without switching tools.

Queens Multilingual Practice: Healthfirst Medicaid and High Patient Volume

A Queens dermatology practice serves a high proportion of Healthfirst Medicaid managed care patients alongside commercial and Medicare populations. DermEstimator correctly applies Locality 04 — Queens' dedicated Medicare locality, separate from the broader NYC Suburbs designation — and maintains separate Healthfirst rate profiles that reflect actual Medicaid MCO reimbursement. The front desk can switch between payer types at check-in, generate accurate estimates for all three populations, and comply with New York's disclosure requirements for each patient type. Multilingual patient communication is handled by printing the estimate and discussing it at intake.

Upstate NY (Buffalo/Rochester) Practice: Excellus BCBS-Heavy Panel

A Buffalo-area dermatology practice operates almost entirely on Excellus BlueCross BlueShield — the dominant upstate New York commercial carrier. DermEstimator applies the Rest of New York (Locality 99) fee schedule, which carries lower geographic adjustment factors than downstate localities, and the practice has uploaded its Excellus contracted fee schedule for precise estimates. When a patient with a high Excellus deductible schedules a skin cancer excision (11600–11646) plus pathology, the front desk generates a same-day estimate showing exactly what the patient will owe after their deductible and coinsurance — no spreadsheets, no phone calls to the billing department.

New York Dermatology Billing FAQ

How many Medicare localities does New York have for physician fee schedule purposes?

New York has five Medicare Physician Fee Schedule localities as of 2026: Locality 01 (Manhattan — New York County), Locality 02 (NYC Suburbs/Long Island — Bronx, Kings, Nassau, Richmond, Rockland, Suffolk, Westchester), Locality 03 (Poughkeepsie/N. NYC Suburbs — Hudson Valley counties), Locality 04 (Queens — its own separate locality), and Locality 99 (Rest of New York — all other counties including Buffalo, Rochester, and Syracuse). DermEstimator auto-detects the correct locality from your practice ZIP code.

Does New York have its own surprise billing law in addition to the federal No Surprises Act?

Yes. New York operates a dual compliance framework. New York Public Health Law § 24 requires providers to disclose estimated charges upon patient request — a state requirement that predates and operates independently of federal NSA. New York Financial Services Law Article 6 governs balance billing protections for insured patients, and in some cases provides stronger protections than the federal NSA — particularly for fully-insured health plans. DermEstimator's estimate generation covers both: the front desk can produce a written cost disclosure at any point in the scheduling process.

Which New York commercial payers does DermEstimator support out of the box?

DermEstimator includes payer profiles for Empire BlueCross BlueShield (Anthem), Excellus BlueCross BlueShield (upstate NY), Aetna, UnitedHealthcare, Cigna, Healthfirst, Fidelis Care, and MetroPlusHealth. For practices with negotiated contracts, a CSV fee schedule upload takes under five minutes and makes every estimate contract-accurate. Medicare and Medicaid payer profiles are included by default.

How does DermEstimator handle Healthfirst and Fidelis Care Medicaid patients?

DermEstimator supports custom payer profiles for Medicaid managed care organizations including Healthfirst and Fidelis Care. Because Medicaid MCO rates are typically at or below Medicare, entering your actual Medicaid fee schedule ensures patient estimates accurately reflect their cost-sharing. The estimator handles commercial, Medicare, Medicare Advantage, and Medicaid payer types from the same interface — no configuration changes required between patient types.

Is DermEstimator HIPAA-compliant for New York practices, including SHIELD Act considerations?

DermEstimator is built with a HIPAA-aware architecture. Estimates are generated without requiring patient PHI — you enter procedure codes and insurance parameters, not patient names or dates of birth. This design also minimizes exposure under New York's SHIELD Act (Stop Hacks and Improve Electronic Data Security Act), which imposes data security requirements on businesses handling New York residents' private information. See our HIPAA & Security page for full details.

How does DermEstimator handle multi-stage Mohs surgery billing for New York dermatologists?

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). For Manhattan Mohs surgeons billing under Locality 01 — the highest-reimbursing Medicare locality in the US — DermEstimator automatically applies the correct geographic adjustment factors. Add-on codes are correctly excluded from the multiple procedure rule and calculated at 100% allowable.

Start Giving New York Patients Accurate Estimates

Set up takes minutes. All five New York localities — including Manhattan's Locality 01 — are already loaded. Try free for 7 days — no credit card required.

See pricing — plans start at $30/month. Read our dermatology billing guides →

Start Free Trial