Billing and Coding: Cosmetic and Reconstructive Surgery

Coverage for cosmetic and reconstructive surgical procedures is determined by LCD L38914 and requires that services be reasonable and necessary per that LCD. Specific documentation is required for each listed service (dermabrasion for rhinophyma; panniculectomy; breast implant removal; reduction mammaplasty; mastectomy for gynecomastia; rhinoplasty; septoplasty), including clinical findings, prior conservative treatments and responses, and procedure-specific operative/pathology reports or lab results. Non-covered services must not be billed as covered and must be billed with the appropriate modifier.

"Cosmetic and reconstructive surgical services described are covered only when they meet the reasonable and necessary requirements of LCD L38914."

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