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Medicare Coverage for Plastic Surgery


If you are a Medicare beneficiary, you may be asking, Does Medicare cover plastic surgery? However, the answer is complex.

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Depending on the circumstance and procedure, Original Medicare may or may not cover plastic surgery. Medicare will not cover elective plastic or cosmetic surgery. Yet, medically necessary plastic surgery may receive coverage.

Below, we review Medicare’s guidelines for plastic surgery benefits. We review what Medicare covers, what is not, and how to find a physician to cover your services. Most importantly, we answer your original question, does Medicare cover plastic surgery?

Does Medicare Provide Coverage for Plastic Surgery?

Original Medicare typically does not cover elective cosmetic surgeries. However, Medicare may cover a medically necessary plastic surgery procedure.

Plastic surgery and cosmetic surgery are not the same. Plastic surgery repairs body parts that may suffer damage due to disease, trauma, or birth defects. Meanwhile, cosmetic surgery enhances certain features of your face or body.

Because the two types of surgeries are not the same, different doctors often perform them. However, many certified plastic surgeons also perform cosmetic procedures.

Medicare will only cover medically necessary plastic surgery after other treatment options have been unsuccessful. There is no circumstance where Medicare will cover elective cosmetic surgery.

Does Medicare Cover Plastic Surgery for Skin Removal or Tummy Tuck After Weight Loss?

Original Medicare will only cover a tummy tuck (abdominoplasty) if medically necessary after extreme weight loss or bariatric surgery. To be medically necessary, the loose skin must be causing discomfort or rash or interfere with your ability to perform daily tasks. Additionally, the procedure can treat an abdominal wall defect.

To qualify for Medicare coverage, you must maintain your weight for at least six months, monitored by a physician. Further, you must try other ways to reduce the loose skin for at least three months. You must provide documented progress and have a physician recommend the procedure.

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Does Medicare Cover Plastic Surgery for Breast Reduction?

There are cases when Medicare will cover breast reduction surgery. These include when you suffer from neck and back pain from large breasts. You can curb this pain and improve posture and breathing habits by receiving a breast reduction.

To qualify for a breast reduction surgery, you must have ongoing symptoms for at least six months and try non-surgical treatments with no improvement. However, Medicare will only cover breast prostheses if you have breast cancer.

If you have breast cancer, a lumpectomy or mastectomy can occur immediately or years later, depending on your needs.

Does Medicare Cover Plastic Surgery After Mohs Surgery?

Mohs surgery can be crucial when treating certain skin cancers. A dermatologist often recommends this surgery to help remove cancerous skin cells.

This procedure involves removing skin tissue to remove the cancerous cells. However, Medicare will not cover plastic surgery after Mohs surgery in most cases.

Original Medicare will cover the Mohs surgery procedure. However, it will not cover the cost of reconstructive surgery for the removed skin.

What Plastic Surgery Procedures Does Medicare Cover?

Original Medicare will cover plastic surgery when it reconstructs an area of the body that has suffered damage due to an operation or injury. Medicare must provide approval for the procedure to receive coverage.

Typical covered conditions include:

  • Accidental injury – If you are injured in an accident that produced visible trauma to a part of your body, you may be eligible for Medicare-covered plastic surgery. For example, if you fall and suffer damage to your mouth, Medicare may cover the required plastic surgery to restore your mouth’s prior appearance and functionality.
  • Breast reconstruction after mastectomy – Suppose you are diagnosed with breast cancer and have a mastectomy. In that case, Medicare will typically cover the reconstruction surgery for your breasts as well as external breast prosthesis and post-surgical bras.
  • Malformation – Medicare will cover plastic surgery to repair malformed body parts if deemed medically necessary. However, malformation is the trickiest plastic surgery procedure to be approved. If the surgery is not deemed medically necessary, Medicare will not cover it.
  • Rhinoplasty – Rhinoplasty is a nose job. Medicare will cover the plastic surgery costs if you require a nose job to help alleviate strained breathing, fix a congenital defect or traumatic injury, or treat chronic nasal obstruction. However, the procedure must be medically necessary, and your physician must prove that a less invasive treatment option will not adequately treat the complication.
  • Vein Ablation – Vein ablation can treat veins that cause skin ulcerations, decrease the frequency of superficial thrombophlebitis, and treat pain and swelling that will not go away with medication.
  • Blepharoplasty – If you suffer from painful eye spasms, nerve palsy in your eye, obstructive upper eyelid, or complications from other medical conditions, Medicare may cover blepharoplasty. Additionally, if plastic surgery is necessary in preparation for a prosthetic eye, Medicare will also cover the cost of the surgery.
  • Botox injections – This may come as a surprise as Botox injections are typically considered a cosmetic procedure. However, in many cases, Botox can treat severe migraines and muscle spasms in the neck. If you have tried other medications and nothing is working, Medicare may cover the cost of Botox injections as treatment.

The above list is not all-encompassing when it comes to Medicare-covered plastic surgery. However, it is some of the most popular covered surgeries. In every case, your physician must deem the surgery medically necessary, and the case will have to be reviewed individually by Medicare to decide if the treatment will receive coverage.

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What Plastic Surgery Procedures Does Medicare Not Cover?

If plastic surgery is not medically necessary, Original Medicare will not provide coverage. If a surgery’s sole purpose is to alter your appearance for cosmetic reasons, you must pay out-of-pocket.

Common cosmetic surgeries Original Medicare does not cover are:

  • Facelift
  • Breast Lift
  • Body contouring 

Medicare Plastic Surgery Prior Authorization Process

For Medicare to cover plastic surgery, it must pass a prior authorization process. This process requires authorization before the surgery. If the doctor’s office fails to receive prior approval, Medicare will not cover the costs of the procedure.

Your physician’s office must provide Medicare with medical records indicating that plastic surgery is medically necessary. Based on your medical records, a Medicare Administrative Contractor will determine whether Medicare will pay for the procedure.

Each Medicare Administrative Contractor can individually determine the necessity of the requested procedure. So, a procedure may receive coverage under one condition but not under another. This process can take up to two or more weeks.

Once an Administrative Contractor approves a procedure, Medicare will cover the costs. However, if the prior authorization is denied, your physician may provide more documentation until it is approved. Or, you may be responsible for the full cost of the procedure.

If your prior authorization request was denied or your physician did not get proper clearance from Medicare, you may need to sign an Advance Beneficiary Notice. This is a document stating that Medicare may not cover your costs, and you could need to cover the services in full.

How Much Does Plastic Surgery Cost With Medicare?

The cost of plastic surgery with Medicare varies depending on the type of surgery.

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If you receive a Medicare-covered plastic surgery that requires an inpatient hospital stay, Medicare Part A and Part B will cover your costs. However, if you are receiving an outpatient plastic surgery procedure, Medicare Part B will provide coverage. Additionally, any medications you require following the surgery will receive coverage by Medicare Part D.

Since most medically necessary plastic surgeries are inpatient, Medicare Part A will cover your first 60 days in the hospital at 100% after you meet the Medicare Part A deductible. Then, after you reach the Medicare Part B deductible, your plan will cover you at 80%. However, you can enroll in a Medicare Supplement plan to help offset these costs.

How to Find Plastic Surgeons Who Accept Medicare

If Original Medicare approves a plastic surgery, you will need to find a plastic surgeon in your area who accepts Medicare and will perform the procedure. However, you will not receive 100% coverage. You will still be responsible for the cost-sharing associated with Medicare Part A and Part B. To cover these costs, people often enroll in a Medicare Supplement plan.

To review available plans in your area or find out how you can save money with Medicare, contact a licensed agent today, and they will provide you with a free plan comparison of all the top options in your area.

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Cosmetic and Reconstructive Surgery,CMS . Accessed June 2022.
    https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35090&ver=95&=
  2. Cosmetic Surgery, Medicare. Accessed June 2022.
    https://www.medicare.gov/coverage/cosmetic-surgery

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

53 thoughts on “Medicare Coverage for Plastic Surgery

  1. Medicare covers liposuction for lipedema that’s considered reconstructive and medically necessary. You will likely have to appeal a denial multiple times. You need a doctor to write an expert opinion letter explaining that the liposuction 1) restores to a normal appearance 2) improves function (ability to walk or exercise 3) improves Quality of Life 4) is safe (no comorbidities. These all meet the requirements for reconstructive, medically necessary surgery. There are dozens of peer-reviewed studies indicating that liposuction for lipedema is safe and effective–and the only treatment once all conservative measures have failed.

    1. Hi Jeffrey! This is great information, thank you so much for sharing! I will update the content accordingly.

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