Billing and Coding: Cosmetic and Reconstructive Surgery

This policy covers reconstructive surgery for abnormal body structures resulting from congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease and specifies detailed documentation requirements for specific procedures (breast reduction, gynecomastia mastectomy, rhinoplasty/septoplasty, panniculectomy, dermabrasion, rhytidectomy, hair transplant, tattooing). Cosmetic surgery to reshape normal structures for appearance or self-esteem is non-covered; use diagnosis code Z41.1, GY modifier, and condition code 21 for non-covered/no-payment submissions, and maintain complete, legible medical records that support medical necessity. Appeals of Medicare payment determinations (including non-covered denials) are permitted per policy.

"Reconstructive surgery is covered for abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease when per..."