LCD/NCD Portal

NCD140.4

 

PLASTIC SURGERY TO CORRECT "MOON FACE"

 

 

Effective Date of this Version

• 5/1/1989

 

Benefit Category

• No Benefit Category.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Indications and Limitations of Coverage

• The cosmetic surgery exclusion precludes payment for any surgical procedure directed at improving appearance.

• The condition giving rise to the patient's preoperative appearance is generally not a consideration.

• The only EXCEPTION to the exclusion is surgery

o For the prompt repair of an accidental injury.

Or

o For the improvement of a malformed body member which coincidentally serves some cosmetic purpose.

• Since surgery to correct a condition of "moon face" which developed as a side effect of cortisone therapy does not meet the exception to the exclusion, it is NOT covered under Medicare (§1862(a)(10) of the Act).

 

Cross Reference

• See the Medicare Benefit Policy Manual, Chapter 16, §120.

 

 

Medicare NCD Link