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Printed Date: 9/22/2015
Cosmetic surgery, or expenses incurred in connection with such surgery, are not covered by Medicare. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body member.
Abdominal lipectomy/panniculectomy is surgical removal of excessive fat and skin from the abdomen. When surgery is performed to alleviate such complicating factors as inability to walk normally, chronic pain, ulceration created by the abdominal skin fold, or intertrigo dermatitis, such surgery is considered reconstructive. Preoperative photographs may be required to support justification and should be supplied upon request.
Meets Medical Necessity
Does Not Meet Medical Necessity
• Treatment of neck or back pain
• Improving appearance (i.e., cosmesis)
• Repairing abdominal wall laxity or diastasis recti
• Treating psychological symptomatology or psychosocial complaints
• When performed in conjunction with abdominal or gynecological procedures (e.g., abdominal hernia repair, hysterectomy, obesity surgery) unless criteria for panniculectomy and abdominoplasty are met separately
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Last Updated: 05/14/2020
Applies to: Prior Authorization, JJ Part A, JJ Part B, JM Part A, JM Part B
Article Topics: Appeals, Redeterminations, and PTANs