Panniculectomy/abdominoplasty

Applies to:

All plans

Definition:

Panniculectomy is the surgical procedure that removes excess skin and body fat from the lower abdomen on patients suffering from obesity or who have had a significant weight loss. Abdominoplasty is a procedure involving the removal of excess abdominal skin and/or fat with or without tightening lax anterior abdominal wall musculature.

Medical policy

Panniculectomy/Abdominoplasty - 91444

Panniculectomy/abdominoplasty coverage

The excision of excess abdominal fat and skin is most often a cosmetic procedure and is not a covered benefit. Exceptions for medical necessity or functional impairment may be made if the criteria listed in the medical policy are met.

Non-standard cost-sharing

If/when commercial employer group and MyPriority^® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.

To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.

Panniculectomy/abdominoplasty authorizations

Authorization is required for all patients.

Participating providers use the Auth Request online authorization tool

Non-participating providers use the authorization forms.

Panniculectomy/abdominoplasty billing

See the medical policy for codes that may apply and codes not covered.