Cosmetic and Reconstructive Procedures

This policy covers reconstructive surgery and selected related procedures—such as post‑mastectomy breast reconstruction (including nipple reconstruction and contralateral procedures), scar/keloid revision for symptomatic or function‑limiting scars, skin tag removal that impairs vision or causes recurrent irritation, and FDA‑approved dermal injections or autologous fat transfer for HIV‑associated facial lipoatrophy—to restore form and/or function after congenital defects, developmental abnormalities, trauma, infection, tumors, prior surgery, or disease. Coverage generally requires documented functional impairment or failure of conservative therapy (unless not standard/contraindicated), excludes procedures performed solely for cosmetic purposes (many body‑contouring, augmentation, resurfacing, hair removal, and revisions of implants originally placed for cosmetic reasons), and notes that gender‑affirming and Medicare‑specific cases follow separate policies while appearance‑only reconstructions are reviewed case‑by‑case.