Cosmetic and Reconstructive Surgery

This LCD covers reconstructive cosmetic procedures when they are medically necessary to restore function or correct deformity (e.g., dermabrasion for rhinophyma, panniculectomy for pannus below the symphysis pubis causing refractory intertrigo or functional impairment, implant removal for device complications, reduction mammaplasty meeting Schnur scale thresholds, gynecomastia surgery for ASPS Grade III/IV or persistent symptomatic disease, and rhinoplasty/septoplasty for documented airway obstruction or related pathology). Procedures performed primarily for cosmetic reasons, to improve appearance or self-image, or that do not meet the specific clinical, documentation, and timing requirements (including mandated trials of conservative therapy and weight-stability windows) are not covered.

"Dermabrasion is covered when performed to treat rhinophyma causing tissue overgrowth of the nose."