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 15847 and 15830 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.

Payment will be made for the following potentially cosmetic procedures as reconstructive surgery when performed for the reasons indicated:

Abdominoplasty ("Tummy Tuck")

• When surgery is performed to improve or restore functional impairment or to alleviate pain and physcial discomfort resulting from a condition, disease, illness or congenital birth defect.  Refer to Medical Policy Bulletin S-28 (Cosmetic Surgery vs. Reconstructive Surgery).

Panniculectomy

• When the panniculus or fold hangs at or below the level of the pubis; and the medical records document that the panniculus or fold causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs or remains refractory to appropriate medical therapy (i.e., treatment of the rash includes prescription medications) over a period of three months, or

• When the patient meets all of the following indications:
  • Maintains a stable weight for at least six (6) months for any of the following:
    • Recurrent documented rashes that do not respond to conventional treatment, or
    • Recurrent or non-healing documented ulcers that do not respond to conventional treatment, or
    • When there is a functional impairment, such as significant difficulty with walking.
  • Prior six (6) months of documented treatment substantiating the above should be provided by the subscriber’s physician, and should include photographs.
  • The panniculus or fold hangs to or below the level of the pubis.
  • Has had bariatric surgery, and 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. 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.  
2. 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)