Abdominoplasty ("Tummy Tuck") is a surgical procedure which tightens a lax anterior abdominal wall caused by diastasis recti (the separation of the two rectus muscles along the medial line of the abdominal wall) and removes excess fat and abdominal skin. This procedure reduces the protruding abdomen and provides an overall improvement in the person’s shape and figure.

Panniculectomy/abdominal lipectomy is the surgical resection of the overhanging “apron” of redundant skin and fat in the lower abdominal area. A panniculus or fold is often seen in men or women who have had significant weight loss or in morbidly obese patients.

Report procedure code 15830 when performing a panniculectomy.  Report procedure codes 15830 and 15847 when an abdominoplasty is performed with a panniculectomy.  Procedure code 15847 should only be reported with procedure code 15830.  When an abdominoplasty is performed without panniculectomy, report procedure code 17999.

Covered Services

Panniculectomy/abdominal lipectomy (initial surgery only) may be considered medically necessary for patients who meet all of the following indications:

1. In patients with stable weight for at least six (6) months for any of the following:
   • Recurrent documented rashes that do not respond to conventional treatment.
   • Recurrent or non-healing documented ulcers that do not respond to conventional treatment.
   • When there is a functional impairment, such as significant difficulty with walking.
2. Prior six (6) months of documented treatment substantiating the above should be provided by the    subscriber’s physician, and should include photographs.
3. When the panniculus or fold hangs to or below the level of the pubis.
4. If the patient has had bariatric surgery, he/she is at least 18 months postoperative.

*Conventional treatment may be defined as treatment with oral antibiotics, topical anti-infective medications and adequate hygiene.

Non-Covered Services

1. Abdominoplasty ("Tummy Tuck") is considered cosmetic, and therefore, is ineligible for coverage. Participating, preferred, and network providers can bill the member for the denied services.       
2. Excision, excessive skin, thigh, leg, hip, buttock, arm, forearm, or hand, submental fat pad, other area (15832-15839) is a non-covered service.  Participating, preferred, and network providers can bill the member for the denied services.  
3. Correction of diastasis recti abdominis is a non-covered service.  Participating, preferred, and network providers can bill the member for the denied services.   

1. Blue Cross and Blue Shield of North Carolina, SUR6170

2. Blue Cross and Blue Shield of New York, 7.01.53

3. Anthem Blue Cross and Blue Shield, SURG.00048

4. Highmark Blue Cross Blue Shield Medical Policy S-28  (Cosmetic Surgery vs. Reconstructive Surgery)