Cosmetic and Reconstructive Surgery

This LCD covers reconstructive cosmetic procedures when medical necessity criteria are met, including dermabrasion for rhinophyma, panniculectomy for functionally impairing pannus with refractory intertrigo or ambulatory impairment, removal of breast implants for specific complications, reduction mammaplasty meeting Schnur scale and refractory-symptom criteria, gynecomastia surgery for higher-grade or refractory disease, selected rhinoplasty/septoplasty indications for functional airway issues, and limited treatment for gigantomastia of pregnancy with severe complications. Cosmetic procedures performed solely to improve appearance or self-image (e.g., dermabrasion for acne scarring, cosmetic lipectomy/liposuction, cosmetic breast reshaping, routine mammapexy) are excluded. Documentation must demonstrate failed conservative therapy, objective measurements (e.g., Schnur scale, grooving >1 cm), duration of symptoms, specific implant complications, and, when applicable, weight stability or post-bariatric timing; services are subject to post-payment review and medical audits.