Cosmetic and Reconstructive Procedures – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers reconstructive procedures—including breast reconstruction after mastectomy and microtia repair—when a documented physical/physiological abnormality causes functional impairment and the proposed treatment is proven and likely to restore physiological function, while cosmetic procedures (e.g., scar/tattoo removal, liposuction for undesirable fat, skin wrinkle treatments, hair removal, sclerotherapy) are excluded. Coverage requires medical-record documentation of the impairment and expected efficacy (flap repairs must meet InterQual criteria), removal of leaking/defective silicone prostheses is covered (replacement only if the original prosthesis was reconstructive), many CPT/HCPCS codes are reviewed case-by-case, and member-specific benefits and state/federal mandates govern final coverage.

"Refer to the member specific benefit plan document and applicable federal or state mandates for additional documentation requirements."