Billing and Coding: Plastic Surgery

Cosmetic plastic surgery is excluded (including uncomplicated macromastia, pendulous breasts, or isolated nipple inversion), while reconstructive/therapeutic procedures (e.g., severe burn treatment, facial repair after trauma) are covered. For reduction mammoplasty to be covered you must document severity with a breast‑specific questionnaire, height/weight, clinical signs/symptoms, prior conservative therapies and responses, operative report with tissue weight removed per breast, pathology, use only listed ICD‑10 codes, and make records available to Medicare—failure to meet these requirements will result in denial.

"ICD-10-CM Codes that Support Medical Necessity — Dermabrasion (CPT Codes 15780-15783): L71."

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