Cosmetic and Reconstructive Surgery

Medicare covers reconstructive plastic surgery when performed to improve function or to correct abnormal structures from congenital, developmental, traumatic or disease causes, and covers specified reconstructive procedures (e.g., post‑mastectomy breast reconstruction, implant removal for complications, medically necessary rhinoplasty/septoplasty, panniculectomy for refractory intertrigo). Cosmetic procedures intended solely to improve appearance (including many liposuction, rhytidectomy, purely cosmetic rhinoplasty, and procedures to treat psychiatric/emotional conditions) are excluded. Documentation must demonstrate functional impairment, failed conservative therapy within specified timeframes (e.g., 6 weeks for septoplasty, 6 months for breast reduction conservative care, 3 months for refractory pannus infections), and procedure‑specific evidence such as Schnur scale calculations or preoperative photographs when requested.

"Reconstructive surgery is covered for abnormal body structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease when performed ..."