Effective January 1, 2027, liposuction or lipectomy to treat lipedema of the extremities may be considered medically necessary when all listed criteria are met, including surgery by a hospital credentialed, board certified plastic surgeon, an in-person exam confirming the lipedema findings, documented significant physical functional impairment, no response to at least six consecutive months of optimal medical management including complex decongestive therapy and compression therapy, a postoperative plan to continue compression garments, and a surgical plan removing a maximum of 5 liters of aspirate. Liposuction or lipectomy for lipedema in areas other than the extremities, for lipedema when these criteria are not met, and for lymphedema is investigational. Physiologic lymphatic microsurgeries, including lymphovenous bypass, lymphaticovenous anastomosis, and vascularized lymph node transfer, are investigational for all indications, as is lymphatic microsurgery performed during nodal dissection or breast reconstruction to prevent lymphedema.
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01Effective January 1, 2027: Submit the following documentation for review: history and physical or chart notes; documentation that surgery will be performed by a hospital credentialed, board certified plastic surgeon; documentation supporting the lipedema diagnosis as defined in criterion I.B; documentation of specific significant physical functional impairments, including specific ADLs such as walking, dressing/grooming, toileting, or bathing; documentation of no response to a minimum of six months of conservative therapy including compression therapy and complex decongestive therapy; for a BMI greater than 35 kg/m2, documentation of lack of effect of medically supervised weight loss over six consecutive months of clinic visits; documentation of a postoperative plan that includes compression therapy; and documentation of the amount of aspirate to be removed.
02If any of these items are not submitted, it could impact the review and decision outcome.
03Reporting 38999 for the treatment of lipedema is not appropriate, and reporting 15839 for body parts represented by other specific codes (e.g., thigh, leg) is not appropriate.
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