Cosmetic and Reconstructive Surgery - MEDICAID - KENTUCKY

This policy addresses coverage of cosmetic and reconstructive surgical procedures for Humana Medicaid Kentucky members, including reconstructive surgery and scar revision, cutaneous vascular lesion removal, chemical peels and dermabrasion for actinic keratoses, laser hair removal for recurrent pilonidal cysts, injectable fillers for HIV‑associated lipoatrophy, and rhinophyma excision. Coverage is limited to medically necessary reconstructive procedures for which an objective, measurable functional impairment is present (cosmetic-only procedures are excluded), requires member eligibility and meeting specific criteria (e.g., failed or contraindicated conservative therapy for vascular lesions), and some services are restricted to specified indications.

"It is generally performed to improve or restore bodily function when an objective functional impairment present."