blue cross and blue shield anthiem-Panni Removal
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Medically Necessary:
Panniculectomy is considered medically necessary for the individual who meets the following criteria:
- The panniculus hangs below the level of the pubis (which is documented in photographs); AND
- The individual has achieved significant weight loss and reached a body mass index (BMI) ≤ 30 kg/m2, as well as the following:
- the individual has maintained a stable weight for at least six months; AND
- if the individual has had bariatric surgery, he/she is at least 18 months post operative; AND
- One of the following:
- there are recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment for a period of 3 months; information must be documented in office visit records; OR
- there is difficulty with ambulation and interference with the activities of daily living; information must be documented in office visit records.
Panniculectomy is considered medically necessary as an adjunct to a medically necessary surgery when needed for exposure in extraordinary cir****tances.
Not Medically Necessary:
Panniculectomy is considered not medically necessary when the criteria above are not met.
Panniculectomy is considered not medically necessary as an adjunct to other medically necessary procedures, including, but not limited to, hysterectomy, and/or incisional or ventral hernia repair unless the criteria above are met.
Panniculectomy or abdominoplasty, with or without diastasis recti repair, for the treatment of back pain is considered not medically necessary.
Cosmetic and Not Medically Necessary:
Liposuction is considered cosmetic and not medically necessary for all indications.
Abdominoplasty when done to remove excess skin or fat with or without tightening of the underlying muscles is considered cosmetic and not medically necessary.
Repair of diastasis recti is considered cosmetic and not medically necessary for all indications