Liposuction
DESCRIPTION
Liposuction alone involves the use of a narrow cannula, inserted through a tiny incision, to vacuum the fat layer beneath the skin. The cannula is pushed and pulled through the fat layer, breaking up the fat cells and removing them by suction. Either a vacuum pump or a large syringe can provide the suction. Localized fat is removed from various areas of the body in an attempt to recontour body areas. This method of liposuction is usually performed using local anesthesia.
Tumescent liposuction involves the subcutaneous infiltration of a large volume of local anesthesia that is intended to decrease pain, bleeding, swelling, discomfort, and recovery time. The tumescent solution acts to thicken the subcutaneous fat layer, which is intended to cushion and protect the fat and adjacent tissue from trauma during the procedure. This is a method for performing liposuction surgery using local or general anesthesia.
Ultrasound-assisted liposuction involves the use of ultrasonic vibrations to liquefy fat cells that are then vacuumed out. This can be done either externally with a special emitter or internally with a heated cannula. This technique is intended to remove fat from dense, fibrous areas of the body such as the upper back or enlarged male breast tissue. This technique is often used in combination with the tumescent technique.
Liposuction is usually performed for cosmetic reasons to remove fat distributed in aesthetically unpleasing proportions and has been successful in improving body contour. The best candidates for liposuction are healthy individuals with firm, elastic skin.
POLICY
Liposuction when used to achieve symmetry of the non-diseased breast during reconstructive surgery following mastectomy is considered medically necessary.
Liposuction, using any method for any other condition including obesity, is considered cosmetic.
See also: Abdominoplasty / Panniculectomy / Lipectomy
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.
SOURCES
American Academy of Cosmetic Surgery. (2006). Guidelines for liposuction. Retrieved October 13, 2010 from http://www.cosmeticsurgery.org/surgeons/2006_liposuction_guidelines.pdf.
American Society of Plastic Surgeons. (2009, March). Evidence-based patient safety advisory: Liposuction. Retrieved October 13, 2010 from http://www.plasticsurgery.org/Documents/Medical_Profesionals/Health_Policy/Evidence_Based_Patient_Safety_Advisory_5.pdf.
Complete Guide to Medicare Coverage Issues [Computer software]. (2008, November). Treatment of obesity (NDC 40.5, p. 2 - 33). Ingenix.
Heymann, W. R. (2006). Liposuction in men. Journal of the American Academy of Dermatology, 55 (2), 311 - 312. (Level 5 Evidence)
Katz, B. E., & Maiwald, D. C. (2005). Power liposuction. Dermatologic Clinics, 23 (3), 383 - 391. (Level 5 Evidence)
Medicare Benefit Policy Manual. (2010, April). General exclusions from coverage. (Chapt 16, 120) Retrieved October 13, 2010 from http://www.cms.gov/manuals/Downloads/bp102c16.pdf.
National Institute of Health and Clinical Excellence. (2008, February). Liposuction for chronic lymphoedema. Retrieved April 7, 2009 from http://www.nice.org.uk/.
U.S. Food and Drug Administration. (1998, July). Center for Devices and Radiological Health. 510K Pre-market Notification Database. K981215 . Retrieved October 13, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K981215.pdf.
U.S. Food and Drug Administration. (1999, September). Center for Devices and Radiological Health. 510K Pre-market Notification Database. K992282 . Retrieved October 13, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K992282.pdf.
ORIGINAL EFFECTIVE DATE: 10/1998
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.
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