Liposuction
DESCRIPTION
Liposuction 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 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.
Reconstructive surgery can be performed to restore normal form or function that is absent due to congenital causes, accident, or disfigurement from a disease state. Symmetry is defined as correspondence in shape, size, and relative position of parts on opposites of the body.
NOTE: Liposuction for lymphedema is not addressed by this policy. Lipectomy and Liposuction for Lymphedema is addressed in a separate policy. Liposuction for lipedema is not addressed by this policy. Liposuction and Lipectomy for Lipedema is addressed in a separate policy.
POLICY
Liposuction when used to achieve breast symmetry during reconstructive surgery following mastectomy is considered medically necessary. (See Applicable Tennessee State Mandate Requirements below.)
Liposuction, using any method for any other condition including, but not limited to, obesity is considered cosmetic.
APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS
Tenn. Code Ann. ยง 56-7-2507 Reconstructive breast surgery.
((a) (1) Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, or managed care organization that provides coverage for mastectomy surgery shall provide coverage for all stages of reconstructive breast surgery on the diseased breast as a result of a mastectomy, but not including a lumpectomy, as well as any surgical procedure on the non-diseased breast deemed necessary to establish symmetry between the two (2) breasts in the manner chosen by the patient and physician. The surgical procedure performed on a non-diseased breast to establish symmetry with the diseased breast must occur within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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 or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
SOURCES
Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 25 Mandated Insurer or Plan Options: 56-7-2507. Reconstructive breast surgery. Retrieved January 10, 2024 from https://advance.lexis.com/.
U.S. Food and Drug Administration. (2008, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K081593. Retrieved July 26, 2012 from http://www.accessdata.fda.gov.
U.S. Food and Drug Administration. (2010, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K092066. Retrieved July 26, 2012 from http://www.accessdata.fda.gov.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 2/8/2024
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.