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Surgical Treatments for Lymphedema and Lipedema
Effective date
Jan 1, 2027
Identified
Jun 17, 2026
Summary
This policy has been revised, and the revised policy takes effect January 1, 2027. Liposuction or lipectomy for lipedema of the extremities may be considered medically necessary when all criteria A through G are met. Lymphatic physiologic surgery for lymphedema and liposuction for lymphedema are considered investigational.
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What to do
Action · 8 steps
01Future transition January 1, 2027: Billing team: For lipedema liposuction or lipectomy of the extremities, submit history and physical or chart notes showing that surgery will be performed by a hospital credentialed, board certified plastic surgeon.
02Also submit documentation supporting the lipedema diagnosis, including bilateral symmetric adiposity, non-pitting edema, pain and tenderness, a negative Stemmer sign, and photographs.
03Submit documentation of significant physical functional impairment, including specific ADLs, and of no response to at least three consecutive months of complex decongestive therapy and compression therapy.
04Submit documentation of a post-operative plan to include compression therapy.
05For BMI greater than 35 kg/m2, submit documentation of lack of effect of medically supervised weight loss over three consecutive months.
06If any of these items are not submitted, it could impact the review and decision outcome.
07Liposuction for areas other than extremities, or when the criteria are not met, is investigational.
08Reporting 38999 for the treatment of lipedema is not appropriate, since lipedema is not a disease of the lymphatic system.
Codes mentioned
15832158331583415835158361583715838158391587615877158781587938999
Original notice
Surgical Treatments for Lymphedema and Lipedema
beonbrand.getbynder.com · Always check the source before changing claims.