This is included more as a thought experiment. I don’t know if the “comparable procedure” argument would have any weight with an appeal review committee concerning reimbursement for liposuction for lipedema. I’ve never tried this strategy. However, if you’re working on your second or third-level appeal, it might be worth it to add this to the argument. If you use it and it works please let me know!
The bottom line is that lipedema has as least as much, and it could be argued more of an impact on the patient’s function, gait, mobility, and Quality of Life as other procedures that the carrier currently reimburses as reconstructive. I have listed several below. The goal here is not to diminish the impact of reconstructive surgery for mastectomies or cleft palate repair, but to add LS-TL as a comparable procedure for an equally debilitating condition. It has taken many years for other procedures to be accepted as reconstructive and not cosmetic. Liposuction has a long way to go until it’s widely accepted as reconstructive for lipedema. The education process will take years.
Reconstructive Liposuction: Care should be taken to refer to LS-TL for lipedema as reconstructive and never cosmetic.
Comparable Treatments now considered reconstructive [MAR 2020]
Medicare Part B Breast prostheses reimbursement: Medicare Part B (Medical Insurance) covers some external breast prostheses (including a post-surgical bra) after a mastectomy. Part A covers surgically implanted breast prostheses after a mastectomy if the surgery takes place in an inpatient setting. Part B covers the surgery if it takes place in an outpatient setting. The patient pays 20% of the Medicare-approved amount for the doctor’s services and the external breast prostheses. The Part B deductible applies.
Medicare reimburses for:
- Breast prosthesis
- Panniculectomy
- Bariatric surgery
- Upper-eyelid surgery ([blepharoplasty] blocks vision) versus lower-eyelid lid surgery (considered cosmetic).
- Cleft lip repair; 15 states require this a reconstructive;
Cleft Lip Repair: State law requires reimbursement in 15 states for cleft lip repair as reconstructive.
Liposuction as an adjunct to Abdominoplasty and Panniculetomy (Tummy Tuck):
Aetna Cosmetic Surgery Policy [CPB-0031]: liposuction when performed with a panniculectomy and also liposuction when performed with breast reconstruction after a mastectomy and not lipedema is considered reconstructive and not cosmetic. Update due 1-9-2020.
Documentation must demonstrate to the medical insurance company the patient has completed conservative non-surgical treatment of lipedema without adequate relief of their lipedema symptoms.
Note that in addition to healthcare carrier policies, there are both federal and state laws regulating reimbursement for certain procedures as reconstructive. Breast reconstruction is both a federal law and there are individual state laws (requiring reimbursement).