Plastic Surgery
L37020
Covered: reconstructive procedures required to improve function (congenital, developmental, trauma, infection, tumor, disease), reduction mammoplasty for symptomatic macromastia or symmetry after cancer, implant removal for specified complications, male gynecomastia Grade III/IV repair, abdominal lipectomy/panniculectomy for specified complications, and suction-assisted lipectomy only for medically necessary lipoma removal; purely cosmetic procedures (e.g., post‑acne dermabrasion, cosmetic rhinoplasty, cosmetic liposuction, elective facial/breast surgery or psychiatric/emotional indications) are excluded (complications of cosmetic surgery may be covered). Key requirements: strict documentation of medical necessity and appropriate ICD‑10 codes with records available to Medicare (reduction mammoplasty requires ≥6 months of refractory symptoms, pre-op photos/pathology/operative tissue weights/height‑weight and symptom questionnaire; panniculectomy requires ≥3 months refractory symptoms; lipoma removal requires clear medical justification).