Abdominoplasty / Panniculectomy / Lipectomy
DESCRIPTION
Abdominoplasty, also known as a tummy-tuck, is a surgical procedure that tightens the anterior abdominal wall and removes the excess abdominal skin and other tissue.
Panniculectomy is a surgical procedure that involves the excision of the panniculus (abdominal fat apron) to remove excess skin and fat.
Lipectomy is a surgical technique that is used to cut and remove unwanted fat deposits from specific areas of the body. These areas include: chin, neck, cheeks, upper arms, above the breasts, abdomen, buttocks, hips, thighs, knees, calves and ankles. It is not a substitute for weight reduction, but is a method of removing localized fat that does not respond to dieting and exercise. A lipectomy is done for cosmetic reasons or to treat functional impairment.
Functional impairment is defined as having extensive redundancy of skin and fat folds in varied anatomic locations causing functional problems. This may result from losing or gaining massive amounts of weight. These areas include medial upper arms, breasts (male and female), and the abdomen and medial thighs. An abdominal fold hanging below the pubis would be one example of functional impairment and the surgical treatment of this condition would be spoken of as an abdominoplasty.
POLICY
Abdominoplasty/Panniculectomy/Lipectomy for functional impairment is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Lipectomy for any other condition is considered cosmetic.
MEDICAL APPROPRIATENESS
Abdominoplasty/Panniculectomy/Lipectomy is considered medically appropriate for an individual with symptomatic functional impairment if ANY ONE of the following criteria are met:
Condition is beyond normal variation in body morphology with impairment of hygiene (e.g., recurrent skin infections, chronic rashes, uncontrollable intertrigo, subcutaneous abscesses) that is refractory to medical management
Panniculus hangs at or below the symphysis pubis, as demonstrated by pre-operative photographs (color photos preferred)
Panniculitis has been documented
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
This policy does not apply to true lipomas.
SOURCES
American Society of Plastic Surgeons. (2006, July). Practice parameter for abdominoplasty and panniculectomy unrelated to obesity or massive weight loss. Retrieved May 6, 2008 from http://www.plasticsurgery.org/medical_professionals/health_policy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=18807.
American Society of Plastic Surgeons. (2006, July). Practice parameter for surgical treatment of skin redundancy for obese and massive weight loss patients. Retrieved May 8, 2008 from http://www.plasticsurgery.org/medical_professionals/health_policy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=18091.
National Guideline Clearinghouse. (2004, April). Practice advisory on liposuction. Retrieved May 6, 2008 from http://www.guidelines.gov.
Townsend, C. M., Jr., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. (Eds.). (2008). Sabiston Textbook of Surgery (18th ed.). Philadelphia: W. B. Saunders Company.
ORIGINAL EFFECTIVE DATE: 1/11/1983
MOST RECENT REVIEW DATE: 1/13/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.