Billing and Coding: Cosmetic and Reconstructive Surgery

This policy supports coverage for reconstructive surgery addressing abnormal body structures caused by congenital, developmental, traumatic, infectious, neoplastic, involutional, or disease processes when procedures are medically necessary to improve function or approximate normal appearance. Cosmetic procedures intended solely to improve appearance or self-esteem are non-covered (use ICD Z41.1 and modifier GY for non-covered billing); comprehensive, legible documentation in the medical record is required, including specific preoperative, operative and diagnostic details and time-based trials of conservative therapy where specified.

"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..."

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