CommercialCoverageHigh impact
Cosmetic and Reconstructive Procedures 7.01.11
Excellus BlueCross BlueShield·Plastic Surgery, Dermatology, General Surgery +3 more·Cosmetic / Reconstructive Surgery
Effective date
Sep 18, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their cosmetic and reconstructive procedures policy effective September 18, 2025, establishing new detailed criteria for determining when procedures are considered reconstructive (covered) versus cosmetic (not covered). The policy provides specific functional deficit requirements and indication-specific criteria for numerous procedures including breast procedures, chest wall deformity corrections, hyperhidrosis treatments, and various skin procedures.
Action Required
Before September 18, 2025: Billing team must update prior authorization and coverage verification processes to incorporate the new functional deficit criteria for reconstructive procedures. Create documentation checklists for providers to ensure all required criteria are met before submitting claims. Update billing system rules to flag cosmetic procedures that may qualify as reconstructive if functional deficits are documented. Train staff on the specific indication criteria for each procedure type to avoid claim denials.