Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | B-35 |
Topic: | Abdominoplasty and Panniculectomy |
Effective Date: | August 1, 2005 |
Issued Date: | August 1, 2005 |
Date Last Reviewed: | 08/2005 |
Indications and Limitations of Coverage
Abdominoplasty 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, also referred to as a “Tummy Tuck”, 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 is often seen in men or women who have had significant weight loss or in morbidly obese patients. Covered Services Panniculectomy/abdominal lipectomy (initial surgery only) may be considered medically necessary for patients who meet all of the following indications:
*Conventional treatment may be defined as treatment with oral antibiotics, topical anti-infective medications and adequate hygiene. Non-Covered Services
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15831 |
1. Blue Cross and Blue Shield of North Carolina, SUR6170 |