Cosmetic and Reconstructive Surgery - Medicare Advantage

This policy covers medically necessary reconstructive surgery and related services for Medicare Advantage members—including removal of benign skin lesions, tissue expander/implant procedures, prosthetic devices (e.g., dentures), and interventions for disease, trauma, tumors, or conditions such as facial lipodystrophy or auricular perichondritis. Purely cosmetic procedures are excluded; coverage is contingent on meeting Medicare/NCD/LCD medical‑necessity criteria (per cited NCDs/LCDs and the Medicare Benefit Policy Manual), and the article specifically excludes actinic keratosis and Mohs surgery.

"Clinical technology is constantly evolving, and we reserve the right to review and update this policy periodically."

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