The Lymph-Sparing, Tumescent Liposuction (LS-TL) Reimbursement Checklist

The most recent Excel version of the checklist is above. 1 Liposuction for Lipedema Reimbursement CHECKLIST. Asterisk * [right] means additional information is available on www.lipoforlipedemareimbursement.com [December 2, 2020] Check website for updates.2 Make a decision for surgery (in the future). [Website www.lipoforlipedemareimbursement.com]3 Review your insurance policy for coverage information…. Continue reading

Experimental/ Investigational/ Unproven Treatment Policy Review

Below I reviewed ten Experimental/Investigational (E/I/U) healthcare policies. The goal here is to compare and contrast them. While very similar, there are differences in the definitions, requirements, and restrictions. I have emphasized issues and terms I consider important. Remember my mottos: Words matter Specificity matters Dates matter Accuracy matters Tailoring… Continue reading

Medical Necessity for Liposuction for Lipedema

This term has different means depending on its usage. Many are inter-related. Clinical: It refers to whether treatment of a disease or condition is warranted medically. This is in regard to published Clinical Practice Guidelines (CPGs) for care for a particular condition. There are clinical guidelines for many conditions including… Continue reading

Comparable Reconstructive Procedures Denied as Cosmetic

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… Continue reading

Lipedema comorbidities and threats to the patient’s life

[Clinicians, please feel free to add or make recommendations to this document. You can reach me using the contact form – Jeff]. The main point here is that a carrier will deny your claim if the patient is too sick for the procedure and their concerns are not addressed. This… Continue reading

CPT codes for liposuction for lipedema

What CPT code should I submit for reconstructive liposuction? Continue reading