When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Andersen LP, Klein M, Rosenberg J. Long-term recurrence and complication rates after incisional hernia repair with open onlay technique. BioMed Central. April 28, 2009. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684736/
Accessed October 26, 2018.
Centers for Medicare & Medicaid Services (CMS). Medicare Home Health Agency Manual. Transmittal 301. §232.11: Cosmetic surgery. [CMS Web site]. 06/06/02. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R301HHA.pdf Accessed October 26, 2018.
Centers for Medicare & Medicaid Services (CMS). National Coverage Determination. Routine Costs in Clinical Trials (310.1). [CMS Web site]. 10/09/07. http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=1&ncdver=2&fromdb=true. October 26, 2018.
Company Benefit Contracts.
Novitas Solutions, Inc. Medicare Part B Reference Manual. Chapter 22 - Global Surgery & Related Services. [Novitas Solutions Web site].
Policy: 11.00.01e:Revision of a Previous Cosmetic Procedure
Policy: 11.03.02r:Bariatric Surgery
Policy: 11.08.15v:Reconstructive Breast Surgery