ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities

This policy addresses cosmetic and reconstructive procedures of the trunk, groin, and extremities, including brachioplasty, buttock and thigh lifts, correction of congenital abnormalities, and lipectomy/liposuction. Coverage is provided for brachioplasty and buttock/thigh lifts only when there is a significant functional impairment (e.g., excess skin interfering with ADLs or causing persistent dermatitis, cellulitis, or ulcers) that persists despite optimal medical management and surgery is expected to improve the impairment; correction of congenital abnormalities is covered as reconstructive care, particularly when there is significant variation from normal or functional impact. These procedures are not covered when performed solely for appearance or without significant functional impairment/expected improvement, and lipectomy/liposuction is not covered unless reconstructive/medical-necessity criteria are met for each treated region, including not for obesity without documented lymphedema or lipedema.