Cosmetic and Reconstructive Surgery

Medicare covers reconstructive plastic and maxillofacial procedures when performed to restore function or correct defects caused by congenital anomalies, trauma, disease, surgery, or infection; purely cosmetic procedures to improve appearance are excluded. Specific covered indications include dermabrasion for trauma/disease-related defects, panniculectomy for pannus below the pubis with documented refractory/chronic intertrigo, removal of failed/infected breast implants, medically indicated reduction mammoplasty after failed conservative therapy or for post-cancer symmetry, reconstructive rhinoplasty/septoplasty meeting documented functional criteria, and maxillofacial prostheses following ablative surgery or traumatic resection. Documentation (e.g., photographs, trials of conservative therapy, weight stability, comprehensive treatment plans) and defined time trials (typically 6 weeks for nasal medical therapy, 3 months for refractory intertrigo, 3–6 months weight stability, and 6 months for mammary symptoms) are required for coverage; some complex or exceptional cases require individual consideration.