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Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
MA11.073f

Policy

This policy uses coverage criteria primarily based on applicable Medicare statutes, regulations, NCDs, LCDs, CMS manuals and other applicable Medicare coverage documents. In the absence of fully established coverage criteria from these Medicare coverage documents for a specific medical service or item, the criterion/indication/service indicated by an asterisk below (*) is based on internal coverage criteria developed by the Company in consideration of peer-reviewed medical literature, clinical practice guidelines, regulatory status, and/or expert opinion. 

MEDICALLY NECESSARY

PANNICULECTOMY
Panniculectomy performed solely to change the appearance of any portion of the body, without improving the physiologic functioning of that portion of the body, is considered a cosmetic service. Therefore, they are not eligible for reimbursement consideration because cosmetic services are not covered by Medicare. However, panniculectomy is considered medically necessary and, therefore, covered when all of the following criteria are met:
  • The panniculus (pannus) hangs to or below the level of the pubis.
  • Persistent, chronic ​symptoms are present in the area of the hanging panniculus ​such as any of the following:
    • Ulceration
    • Necrosis
    • Intertrigo (e.g., dermatitis, skin irritation, infection, chafing)​​​​
    • Panniculitis
  • A 3-month course of medical therapy has been ineffective in managing (or controlling) symptoms
    • Examples of agents that may be used for conservative treatment are topically applied skin barriers, supportive garments, and antifungal, antibacterial, and moisture-absorbing agents.
  • The panniculus (pannus) causes significant interference with activities of daily living (e.g., caring for areas of redundant skin and associated hygiene) or problems with ambulation.
  • If panniculectomy is performed to correct redundant tissue after massive weight loss, all of the following criteria must also be met:
    • The individual has maintained a stable weight for at least 6 months.
    • If the individual has had bariatric surgery, panniculectomy should not be performed until at least 18 months after the bariatric surgery.
PANNICULECTOMY PERFORMED ON THE SAME DAY IN CONJUNCTION WITH OTHER MEDICALLY NECESSARY PROCEDURES TO OBTAIN AN ACCESSIBLE SURGICAL SITE*
There are limited, exceptional clinical circumstances when a panniculectomy, performed on the same day in conjunction with another medically necessary procedure​, is considered medically necessary. However, a panniculectomy performed on the same day in conjunction with another medically necessary procedure to obtain an accessible surgical site is ​considered medically necessary and, therefore, covered when any of the respective criteria below are met:
  • Hysterectomy in individuals with a significant panniculus​ (Promidou et al., 2020; Ramzan et al., 2015)
  • In individuals with multiple, recurrent ventral hernias with multiple surgical scars when mesh has been utilized or will be utilized for repair or when a component's separation procedure is anticipated in the surgical plan​ (Rasador et al., 2024; Sosin et al., 2020; ASPS, 2019; Diaconu et al., 2019; Koolen et al., 2014; Zemlyak et al., 2012; Wright et al., 2004; Hopkins et al., 2000)​
  • Abdominal surgery in an individual with the presence of a prior ostomy, open wounds, or exposed draining fistula(ae) from infected mesh (Holland et al., 2024; Elhage et al., 2021; Katkoori et al., 2010)
ABDOMINAL LIPECTOMY​
Abdominal lipectomy performed solely to change the appearance of any portion of the body, without improving the physiologic functioning of that portion of the body, is considered a cosmetic service. Therefore, they are not eligible for reimbursement consideration because cosmetic services are not covered by Medicare. However, abdominal lipectomy is considered medically necessary and, therefore, covered when performed to alleviate all of the following complicating factors of excess skin and fat:
  • Persistent, chronic symptoms are present in the area of the excess skin and fat of the abdomen ​such as any of the following:
    • Ulceration
    • Necrosis
    • Intertrigo (e.g., dermatitis, skin irritation, infection, chafing)​​
  • A 3-month course of medical therapy has been ineffective in managing (or controlling) symptoms
    • Examples of agents that may be used for conservative treatment include topically applied skin barriers, supportive garments, and antifungal, antibacterial, and moisture-absorbing agents.​
  • The excessive skin and fat causes significant interference with activities of daily living (e.g., caring for areas of redundant skin and associated hygiene) or problems with ambulation.
  • If abdominal lipectomy is performed to correct excess skin and fat following significant weight loss, all of the following criteria must also be met:
    • The individual has maintained a stable weight for at least 6 months.
    • If the individual has had bariatric surgery, abdominal lipectomy should not be performed until at least 18 months after the bariatric surgery.
EXCISION OF REDUNDANT SKIN OTHER THAN ABDOMEN/PANNUS*​​​
Excisions of redundant skin performed solely to change the appearance of any portion of the body, without improving the physiologic functioning of that portion of the body, is considered a cosmetic service. Therefore, they are not eligible for reimbursement consideration because cosmetic services are not covered by Medicare​.​ However, excision of redundant skin is considered medically necessary and, therefore, covered when all of the following criteria are met (ASPS, 2017): ​
  • Persistent, chronic symptoms are present in the area of the redundant skin ​such as any of the following:
    • Ulceration
    • Necrosis

    • Intertrigo (e.g., dermatitis, skin irritation, infection, chafing)​

  • A 3-month course of medical therapy has been ineffective in managing (or controlling) symptoms.
    • Examples of agents that may be used for conservative treatment are topically applied skin barriers; supportive garments; and antifungal, antibacterial, and moisture-absorbing agents.
  • The redundant skin causes significant interference with activities of daily living (e.g., caring for areas of redundant skin and associated hygiene) or problems with ambulation.
  • If excision of redundant skin is performed to correct redundant tissue after massive weight loss, all of the following criteria must also be met:
    • Stable weight is maintained for at least 6 months.
    • If the individual has had bariatric surgery, excision of redundant skin other than the abdomen or pannus should not be performed until at least 18​ months after the bariatric surgery.
ABDOMINOPLASTY
When performed as a cosmetic service, abdominoplasty is not covered by the Company because cosmetic services are not covered by Medicare. Therefore, it is not eligible for reimbursement consideration. However, abdominoplasty is considered medically necessary and, therefore, covered when performed in conjunction with panniculectomy or abdominal lipectomy. 

COSMETIC

PANNICULECTOMY
If the criteria for panniculectomy or panniculectomy performed on the same day in conjunction with other medically necessary procedures are not met, panniculectomy is a considered cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

ABDOMINAL LIPECTOMY
If the criteria for abdominal lipectomy is not met, abdominal lipectomy is considered a cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

EXCISION OF REDUNDANT SKIN OTHER THAN ABDOMEN/PANNUS
If the criteria for excision of redundant skin is not met, excision of redundant skin is considered a cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

ABDOMINOPLASTY
Abdominoplasty performed to remove excess skin and fat and to tighten the fascia of the abdominal wall is considered a cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

DIASTASIS RECTI REPAIR
Diastasis recti repair performed to tighten the fascia of the abdominal wall is considered a cosmetic service. Services that are cosmetic are not covered by the Company because cosmetic services are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

All requests for the procedures mentioned in this policy require a review by the Company and must include all of the following:
  • Dated photographs of the panniculus hanging over the pubis and of the panniculus, excessive fat from the abdomen, or redundant skin elevated to expose the chronic, persistent, and refractory skin infection or irritation. chronic, persistent, and refractory skin infection or irritation.
  • Office notes from the treating professional provider that reflect the chronic, persistent, and refractory skin infection or irritation; and when applicable, that persist despite optimal medical care over a three-month period; problems with ambulation; or chronic pain.
  • A listing, when applicable, of the medications that were used to treat the chronic skin infection or irritation during a three-month period and the length of time the agents were used.
  • Documentation when applicable, that demonstrates massive weight loss, weight stability, and date of bariatric surgery.

Guidelines

This policy is consistent with Medicare’s coverage determination. The Company’s payment methodology may differ from Medicare. However, there is no Medicare coverage determination addressing excision of redundant skin other than the abdomen/pannus or diastasis recti repair; therefore, the Company policy is applicable.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, panniculectomy, abdominal lipectomy, and other excisions of redundant skin are covered under the medical benefits of the Company's Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

Services that are cosmetic are excluded for the Company's Medicare Advantage products because they are not covered by Medicare. Therefore, they are not eligible for reimbursement consideration.

Description

PANNICULECTOMY

Panniculectomy is a surgical procedure in which a large, redundant apron of subcutaneous fat and abdominal skin (the panniculus) is removed from the lower abdomen. This redundant apron of skin and fat is caused by a lack of underlying supportive tissue and does not respond to weight loss or exercise, and can occur in people of normal weight and in morbidly obese individuals. Skin chafing may be present under the apron, which may create an environment favorable to bacterial or fungal infections (intertrigo).

It has been proposed that for certain abdominal or gynecologic surgical procedures, including but not limited to incisional/ventral hernia repair or hysterectomy, the presence of a large overhanging panniculus may interfere with the surgery or may compromise postoperative recovery. However, adjuvant panniculectomy in most instances is not essential to improving clinical outcomes of the abdominal or gynecologic surgical procedures. In addition, available published peer-reviewed literature does not indicate that a panniculus contributes to formation of a hernia (a small sac containing tissue that protrudes through an opening in the muscles of the abdominal wall). The main cause of hernia formation is an abdominal wall weakness or defect, not a pulling effect from a redundant or large panniculus.

There are circumstances where a panniculectomy may be indicated in conjunction with other medically necessary surgical procedures. For individuals who are receiving a hysterectomy who concurrently have a large, overhanging, abdominal pannus, a panniculectomy will improve exposure of the operative field and decrease postoperative wound infections. In a person with multiple, recurrent ventral hernias with multiple surgical scars when mesh has been used in the repair, if mesh use is planned in the repair, or when a components separation procedure* is planned, a panniculectomy will remove many of the pre-existing scars which reduce ischemic skin edges and decrease the risk of skin necrosis, mesh exposure, and infection while also decreasing the amount of post-operative tension on the surgical closure. Additionally, in an individual who has a prior ostomy, an open wound(s), or exposed draining fistula(ae) from infected mesh, a panniculectomy will remove infected soft tissues, prior scars, and infected foreign body mesh that may contaminate the new abdominal wall construction.

Panniculectomy may be performed to correct the redundant tissue that occurs in obese individuals after massive weight loss resulting from various regimens such as bariatric surgery. After these individuals experience massive weight loss, many are left with a redundant panniculus that poses a risk for a panniculus bacterial or fungal infection. Weight stability is required before panniculectomy because there is potential for development of another panniculus if additional weight loss occurs, thus increasing the risk of postoperative complications.​

*The Component Separation Technique (CST) is a type of rectus abdominis muscle advancement flap. It was first used to reconstitute the linea alba, reduce abdominal wall tension, and provide a dynamic abdominal wall in persons with large abdominal wall defects. This technique allows reconstruction of a large defect without requiring a free distant transposition flap. The advantages of CST are that it restores structural support of the abdominal wall, provides stable soft tissue coverage, and optimizes esthetic appearance of complex abdominal wall defects and giant midline abdominal wall hernias.



ABDOMINAL LIPECTOMY

Abdominal lipectomy may be performed by plastic surgeons to provide symptomatic, functional, and cosmetic relief for individuals with excess skin along with fat. The excess abdominal skin and fat may be the result of significant weight loss or may be due to obesity. Abdominal lipectomy is different from a cosmetic abdominoplasty in that there is minimal or no abdominal wall undermining and, unless there is a ventral hernia, no abdominal muscle plication is performed.

EXCISION OF REDUNDANT SKIN OTHER THAN ABDOMEN/PANNUS

Extensive redundancy of skin and fat folds can also appear in areas such as the medial aspect of the upper arms, breasts, buttocks, and thighs, and may create environments that are susceptible to skin infection. Fungal dermatitis, bacterial or monilial infection, and/or panniculitis, collectively called "intertrigo," can occur. Medical management by the application of skin barriers, moisture-absorbing agents, and/or the use of supportive garments is indicated as the first line of treatment. However, if the condition is persistent and remains refractory to medical treatment, improvement may be achieved by surgical intervention. Excessive skin and fat are excised using appropriate incisions and techniques that allow for the direct removal of the redundant skin, with the subsequent approximation and suturing of the remaining skin.

In recent years, the surgical correction of morbid obesity and/or stringent diet regimens have assisted many individuals in achieving and sustaining weight loss. Although the benefits of weight loss are obvious, problems that are secondary to weight loss may appear, including skin redundancy with folds of skin and/or fat that are prone to infection. In addition, the aging process itself causes the underlying supportive structures of the skin to sag, which often creates skin redundancy.

ABDOMINOPLASTY

Abdominoplasty is a surgical procedure that is performed to tighten a lax abdominal wall. It involves the removal of excess skin and fat from the middle and lower abdomen: the skin is pulled downward, and the underlying fascia (dense connective tissue that surrounds the muscles) is tightened. This procedure may also include reimplantation of the umbilicus. During an abdominoplasty procedure, a large incision is made across the lower abdomen, and the skin is separated from the abdominal wall up to the ribs. According to the American Society of Plastic Surgeons (ASPS), abdominoplasty is typically performed for cosmetic purposes.

An abdominal wall weakness or defect is also evident in diastasis recti. The main musculature of the abdomen is held together at the anterior midline by a long, triangular structure called the linea alba. The linea alba's insertion is at the xiphoid process of the sternum and extends downward to the pubis. According to medical literature, the condition of diastasis recti presents as a weakness or laxity of the abdominal wall, including the linea alba, but does not constitute a true hernia and is of no clinical significance.

COSMETIC

There may be times when panniculectomy, abdominal lipectomy, and other excisions of redundant skin are performed for cosmetic purposes. Cosmetic services are those provided to improve an individual's physical appearance, from which no significant improvement in physiologic function can be expected. Emotional and/or psychological improvement alone does not constitute improvement in physiologic function.

CLINICAL BENEFITS OF INTERNALLY DEVELOPED COVERAGE CRITERIA 

In accordance with federal regulations, the plan has determined that the use of this additional criterion is necessary to interpret or supplement Medicare's criteria and that it provides clinical benefits that are highly likely to outweigh any clinical harms, including from delayed or decreased access to items or services. For instance, panniculectomy in conjunction with a medically necessary procedure avoids the need for multiple surgical interventions and the morbidities associated with them. Moreover, the plan expanded upon Medicare indications beyond abdomen/pannus to include excision of redundant skin to accommodate individuals with persistently burdensome excess skin that may be contraindicated to medical therapy.

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Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015;136 (5):597.

Wright JD, Rosenbush EJ, Powell MA, Rader JS, Mutch DG, Gao F, Gibb RK. Long-term outcome of women who undergo panniculectomy at the time of gynecologic surgery. Gynecol Oncol. 2006;102(1):86-91.

Zemlyak AY, Colavita PD, El Djouzi S, Walters AL, et al. Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. Surg Res. 2012;177(2):387-391. 

Coding

CPT Procedure Code Number(s)
15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15877
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
​ABDOMINAL LIPECTOMY AND PANNICULECTOMY​ ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:
​​
PRINCIPAL DIAGNOSIS:
L98.7 Excessive and redundant skin and subcutaneous tissue
M79.3 Panniculitis, unspecified

SECONDARY DIAGNOSIS:
L30.4 Erythema intertrigo
R26.2 Difficulty in walking, not elsewhere classified
Z74.09 Other reduced mobility

​FOR OTHER EXCISIONS OF REDUNDANT SKIN:

Report the most appropriate diagnosis code in support of medically necessary criteria as listed in the policy.
HCPCS Level II Code Number(s)
N/A
Revenue Code Number(s)
N/A


Coding and Billing Requirements

Policy History

Revisions From MA11.073f​​:​
12/29/2025This version of the policy will become effective 12/29/2025.

The policy criterion for panniculectomy, abdominal lipectomy, and excisions of redundant skin has been revised. The waiting period after bariatric surgery was revised from 24 to 18 months. 

Chronic pain is no longer a required indication for panniculectomy and abdominal lipectomy eligibility.

Abdominoplasty was added as medically necessary when performed in conjunction with panniculectomy or abdominal lipectomy. 

CMS Benefit/Harm language and in-text citations were added to the policy given internally developed coverage criteria for sections related to panniculectomy performed in conjunction with another medically necessary procedure to obtain an accessible surgical site and excision of redundant skin other than the abdomen/pannus.​

All of the ICD-10 CM codes have been removed from this policy (they were in Attachment A that has been archived). Report the most appropriate diagnosis code in support of medically necessary criteria as listed in the policy.

The following ICD-10 codes were added to the policy as medically necessary when reported with Panniculectomy or Abdominal Lipectomy:
  • Principal Diagnosis: 
    • ​L98.7 Excessive ​and redundant skin and subcutaneous tissue
  • Secondary Diagnosis: 
    • R26.2 Difficulty in walking, not elsewhere classified
    • Z74.09 Other reduced mobility
​The following ICD-10 codes were moved from Attachment A to the coding table, and will remain medically necessary when reported with Panniculectomy or Abdominal Lipectomy:
  • Principal Diagnosis: ​
    • ​​M79.3 Panniculitis, unspecified
  • ​Secondary Diagnosis:
    • L30.4 Erythema intertrigo

Revisions From MA11.073e:​
10/01/2024This policy has been identified for a code update, effective 10/01/2024.

The following ICD-10 codes have been ​added to Attachment A of this policy:​
  • T81.321A Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, initial encounter
  • T81.321D Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, subsequent encounter
  • T81.321S Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, sequela
  • T81.328A Disruption or dehiscence of closure of other specified internal operation (surgical) wound, initial encounter
  • T81.328D Disruption or dehiscence of closure of other specified internal operation (surgical) wound, subsequent encounter
  • T81.328S Disruption or dehiscence of closure of other specified internal operation (surgical) wound, sequela
  • T81.329A Deep disruption or dehiscence of operation wound, unspecified, initial encounter
  • T81.329D Deep disruption or dehiscence of operation wound, unspecified, subsequent encounter​
  • T81.329S Deep disruption or dehiscence of operation wound, unspecified, sequela​

The following ICD-10 codes have been ​deleted from Attachment A of this policy:​
  • T81.32XA, T81.32XD

Revisions From MA11.073d:
​09/04/2024
​This policy has been reissued in accordance with the Company's annual review process.​
​01/01/2024
​Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.​
05/03/20​23​This policy has been reissued in accordance with the Company's annual review process.​​
​06/15/2022
​This policy has been reviewed and reissued to communicate the Company's continuing position on Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin.
​07/11/2021
​This version of the policy will be issued on 08/02/2021 and is retroactively effective to 07/11/2021. This policy has been updated in consideration of changes to the Local Coverage Determination Billing and Coding Article A56587​: Cosmetic and Reconstructive Surgery.

The following CPT code has been added to this policy: 15877

Revisions From MA11.073c:
11/18/2020
This policy has been reviewed and reissued to communicate the Company's continuing position on Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin.
06/25/2019
​This policy has been reissued in accordance with the Company's annual review process.
10/01/2018This policy has been identified for the ICD-10 CM code update, effective 10/01/2018.

The following ICD-10 CM narratives have been revised in this policy:

L98.495, L98.496, L98.498

Revisions From MA11.073b:
09/26/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin.
10/01/2017This version of the policy will become effective 10/01/2017.

The following ICD-10 CM codes have been added to this policy:

L97.105, L97.106, L97.108, L97.115, L97.116, L97.118, L97.125, L97.126, L97.128, L97.205, L97.206, L97.208, L97.215, L97.216, L97.218, L97.225, L97.226, L97.228, L97.305, L97.306, L97.308, L97.315, L97.316, L97.318, L97.325, L97.326, L97.328, L97.405, L97.406, L97.408, L97.415, L97.416, L97.418, L97.425, L97.426, L97.428, L97.505, L97.506, L97.508, L97.515, L97.516, L97.518, L97.525, L97.526, L97.528, L97.805, L97.806, L97.808, L97.815, L97.816, L97.818, L97.825, L97.826, L97.828, L97.905, L97.906, L97.908, L97.915, L97.916, L97.918, L97.925, L97.926, L97.928, L98.415, L98.416, L98.418, L98.425, L98.426, L98.428, L98.495, L98.496, L98.498

Revisions From MA11.073a:
07/07/2017This version of the policy will become effective 07/07/2017.

This policy was updated and expanded to include Company's current position and criteria for excision of redundant skin on areas other than abdomen/pannus.

The following medically necessary policy criteria have been added:
  • Panniculectomy performed when the individual has significant interference with activities of daily living (e.g., caring for areas of redundant skin and associated hygiene) or problems with ambulation and the addition of chronic pain criteria
  • Excision of redundant skin other than abdomen/pannus performed to correct redundant tissue after massive weight loss with criteria
  • Abdominal lipectomy with criteria
The following medically necessary policy criteria have been revised form the required 18 months to 24 months:
  • If the individual has had bariatric surgery, panniculectomy should not be performed until at least 24 months after the bariatric surgery.
The following medically necessary policy criteria have been revised:
  • Panniculectomy performed on the same day in conjunction with another medically necessary procedure to obtain an accessible surgical site for the following:
    • Hysterectomy in individuals with a significant panniculus
    • Abdominal surgery with the presence of a prior ostomy, open wounds, or exposed draining fistula(ae) from infected mesh
The following ICD-10 CM codes have been added to this policy:

L02.214 Cutaneous abscess of groin
L03.314 Cellulitis of groin
L03.324 Acute lymphangitis of groin
L08.0 Pyoderma
L08.1 Erythrasma
L08.89 Other specified local infections of the skin and subcutaneous tissue
L08.9 Local infection of the skin and subcutaneous tissue, unspecified
L98.491 Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin
L98.492 Non-pressure chronic ulcer of skin of other sites with fat layer exposed
L98.493 Non-pressure chronic ulcer of skin of other sites with necrosis of muscle
L98.494 Non-pressure chronic ulcer of skin of other sites with necrosis of bone
L98.499 Non-pressure chronic ulcer of skin of other sites with unspecified severity

Revisions From MA11.073:
11/23/2016This policy has been reissued in accordance with the Company’s annual review process.
10/01/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on Abdominoplasty and/or Panniculectomy
01/01/2015This is a new policy.
12/29/2025
12/29/2025
MA11.073
Medical Policy Bulletin
Medicare Advantage
No
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