Medicare AdvantageCoverageMedium impact
Cosmetic and Reconstructive Surgery - Medicare Advantage (Revised)
Humana·Plastic Surgery, Dermatology, General Surgery +1 more·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Summary
This is a revised Medicare Advantage policy for cosmetic and reconstructive surgery that provides updated coverage criteria and billing guidance for various procedures including skin lesion removal, panniculectomy, rhinoplasty, and scar revision. The policy clarifies when reconstructive procedures are considered medically necessary and references applicable Local Coverage Determinations by jurisdiction.
Action Required
Before March 2, 2026: Billing team must review and update prior authorization requirements and coverage criteria for cosmetic and reconstructive surgery procedures based on applicable Local Coverage Determinations for your jurisdiction. Update billing system rules to ensure proper documentation of functional impairment for reconstructive procedures. Verify coverage criteria for specific procedures like panniculectomy, keloid removal, and rhinoplasty match the revised policy requirements.