Panniculectomy Surgery – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers panniculectomy as reconstructive and medically necessary only when the member meets InterQual® CP: Procedures, Panniculectomy, Abdominal criteria or has documented functional impairment (e.g., persistent panniculitis, chronic back pain, or ADL limitations) after an adequate trial of non‑surgical management; procedures performed primarily for cosmetic reasons (including abdominoplasty, lipectomy/suction‑assisted lipectomy, repair of diastasis recti) or done concurrently with other abdominal/gynecologic surgery are excluded unless InterQual criteria are met. Coverage requires documentation that the clinical criteria/non‑surgical treatment and functional impairment are met and is subject to the member‑specific benefit plan and applicable state/federal mandates.

"Panniculectomy is considered reconstructive and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures, Panniculectom..."