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Cosmetic and Reconstructive Surgery - Medicare Advantage (Revised)
Act
by Mar 2, 2026
Effective date
Mar 2, 2026
Identified
Sep 9, 2026
Summary
This is a revised Medicare Advantage policy on cosmetic and reconstructive surgery effective March 2, 2026. The policy clarifies coverage criteria for multiple procedures including benign skin lesion removal, hair removal, keloid removal, panniculectomy, rhinoplasty/septoplasty, and scar revision. It establishes that reconstructive surgery requires documented functional impairment, and references jurisdiction-specific Local Coverage Determinations (LCDs) by Medicare Administrative Contractor (MAC) regions.
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What to do
by Mar 2, 2026 · 8 steps
01Billing team must update systems to align with this revised Medicare Advantage policy.
02Verify your practice's MAC jurisdiction using the provided table (J5, J6, J8, J15, JE, JF, JH, JL, JJ, JM, or JN) to identify applicable LCDs.
03Update prior authorization requirements for skin lesion removal (CPT 17110, 11400-11406), hair removal (CPT 17380), keloid removal (CPT 11400-11446), panniculectomy (CPT 15830), and rhinoplasty/septoplasty (CPT 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30468) based on jurisdiction-specific LCDs.
04Ensure all reconstructive surgery claims include documentation of functional impairment (defined as direct, measurable reduction in physical performance).
05For hair removal, limit coverage to recurrent pilonidal cyst cases post-surgery; for keloid removal, require functional impairment documentation; for panniculectomy, apply LCD criteria from your jurisdiction.
06Update billing software and encounter forms to reflect these requirements.
07Providers must document medical necessity per jurisdiction guidance.
08Claims lacking required documentation or prior authorization will be denied.
Codes mentioned
171101140011401114021140311404114051140617106171081710717380114462091015830304003041030420304303043530450304603046230468
Original notice
Cosmetic and Reconstructive Surgery - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Cosmetic and Reconstructive Surgery - Medicare Advantage (Revised)MediumEffective Mar 2, 2026 · Medicare AdvantageCosmetic and Reconstructive Surgery - Medicare Advantage (Revised)HighEffective Oct 1, 2026 · Medicare AdvantageCutaneous Vascular Lesion Removal - MEDICAID - KENTUCKY (New)MediumEffective Sep 16, 2026 · MedicaidCutaneous Vascular Lesion Removal - MEDICAID - KENTUCKY (New)HighEffective Sep 16, 2026 · MedicaidBrowse every Humana change in the policy list
Related policy hubs
Humana policiesPlastic SurgeryDermatologyGeneral SurgeryOral & Maxillofacial SurgeryCode 17110Code 11400Code 11401Code 11402Code 11403Code 11404Code 11405Code 11406Code 17106Code 17108Code 17107Code 17380Code 11446Code 20910Code 15830Code 30400Code 30410Code 30420Code 30430Code 30435Code 30450Code 30460Code 30462Code 30468