LCD Reference Article Response To Comments Article

Response to Comments: Cosmetic and Reconstructive Surgery

A58772

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Article ID
A58772
Original ICD-9 Article ID
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Article Title
Response to Comments: Cosmetic and Reconstructive Surgery
Article Type
Response to Comments
Original Effective Date
05/27/2021
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The following are the comment summaries and contractor responses for First Coast Service Options, Inc. Proposed Local Coverage Determination (LCD) DL38914 (Cosmetic and Reconstructive Surgery) which was posted for comment on January 14, 2021 and presented at the January 2020 Open Meeting. All comments were reviewed and incorporated into the final LCD where applicable.

Response To Comments

Number Comment Response
1

One comment was received asking if the LCD allows coverage for abdominoplasty and more specifically as to whether the LCD provides covered indications for abdominoplasty procedures.

Also, under the covered indications section of the proposed LCD, the commenter requests clarification of the definition for the criteria “significant weight loss” requesting more specific language when addressed under Panniculectomy coverage (i.e., provide specific numbers or percentages that can be used in order to compare to whether or not the members weight loss would be considered significant enough to warrant approval of a panniculectomy).

Thank you for your comment. One of the intentions of this proposed LCD is to provide coverage for the surgical treatment involving the removal of the excess skin and fat that occurs in obese patients following weight loss. Panniculectomy involves the removal of hanging excess skin/fat in a transverse or vertical wedge but does not include muscle plication, neoumbilicoplasty or flap elevation. Abdominoplasty is typically performed for cosmetic purposes and involves the removal of excess skin and fat from the pubis to the umbilicus or above, which may include fascial plication of the rectus muscle diastasis and a neoumbilicoplasty. A cosmetic abdominoplasty is sometimes performed at the time of a functional panniculectomy or delayed pending completion of weight reduction (when the patient reaches their ideal bodyweight). Abdominoplasty is considered reasonable and necessary and is considered reconstructive when it is performed with a panniculectomy to assist in the correction of a functional impairment and meets the indications and limitations as stated in this proposed LCD. Neither specific weight loss nor a patient's BMI is listed as an indication for a panniculectomy as this varies based on individual clinical circumstances. As stated in the LCD, a panniculectomy is medically reasonable and necessary when the excess and hanging skin, as a result of the substantial and sustained weight loss, is causing one or more problems for the patient to include, chronic intertrigo a skin condition that does not respond to appropriate medical therapy or difficulty walking or functional impairment in Activities of Daily Living (ADLs).

The LCD was revised to clarify the limitation under Abdominal Lipectomy/Panniculectomy "Repairing abdominal wall laxity, or diastasis recti."

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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