Abdominoplasty reimbursement

Abdominoplasty reimbursement refers to insurance payments for abdominoplasty procedures when medically necessary, such as correcting abdominal wall defects or treating chronic rashes unresponsive to medical therapy. Insurers like Aetna and Cigna typically deny claims for cosmetic abdominoplasty but may approve coverage if documentation shows functional impairment, including recurrent skin infections or hernias.

Medical necessity criteria require physician notes detailing failed conservative treatments, photographs of affected areas, and evidence of interference with daily activities, according to YourInsurance.info. CPT code 15847 identifies abdominoplasty in billing; insurers only reimburse this code when paired with qualifying diagnoses (e.g.

ICD-10 L98.491 for non-healing wounds). Medicare rarely covers abdominoplasty except after massive weight loss resulting in persistent panniculitis documented by multiple office visits over at least three months.

Preauthorization is mandatory; without insurer preapproval, patients pay the full cost–averaging $6,000–$12,000 out-of-pocket per American Society of Plastic Surgeons data from 2022. Appeals succeed more often when physicians submit operative reports showing failed prior surgeries or complications like ventral hernia repair (CPT 49560) performed concurrently.

Denials cite lack of medical necessity most frequently according to UnitedHealthcare’s published policy guidelines updated March 2023.