Billing and Coding: Cosmetic and Reconstructive Surgery

This billing and coding guidance refers to LCD L35090: Medicare covers cosmetic versus reconstructive surgery when procedures meet the LCD's reasonable and necessary criteria and documentation requirements. The policy specifies detailed documentation to support medical necessity for procedures such as dermabrasion for rhinophyma, panniculectomy, breast implant removal, reduction mammaplasty, gynecomastia mastectomy, rhinoplasty, and septoplasty, and requires that non-covered services not be billed as covered and be reported with appropriate modifiers.

"Services that meet the Medicare reasonable and necessary requirements per Local Coverage Determination (LCD) L35090 are covered when billed as reconstructive or medically necessary procedures."

Sign up to see full coverage criteria, indications, and limitations.