This is included more as a thought experiment. I don\u2019t know if the \u201ccomparable procedure\u201d argument would have any weight with an appeal review committee concerning reimbursement for liposuction for lipedema. I\u2019ve never tried this strategy. However, if you\u2019re 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!<\/p>\n\n\n\n
The bottom line is that lipedema has as least as much, and it could be\nargued more of an impact on the patient\u2019s function, gait, mobility, and Quality\nof Life as other procedures that the carrier currently reimburses as\nreconstructive. I have listed several below. The goal here is not<\/em> to diminish the impact of\nreconstructive surgery for mastectomies or cleft palate repair, but to add\nLS-TL as a comparable procedure for an equally debilitating condition. It has\ntaken many years for other procedures to be accepted as reconstructive and not\ncosmetic. Liposuction has a long way to go until it\u2019s widely accepted as\nreconstructive for lipedema. The education process will take years.<\/p>\n\n\n\n Reconstructive Liposuction<\/strong>: Care should be taken to refer to LS-TL for\nlipedema as reconstructive <\/em><\/strong>and never cosmetic<\/em><\/strong>.<\/p>\n\n\n\n Comparable Treatments now\nconsidered reconstructive [MAR 2020]<\/strong><\/p>\n\n\n\n Medicare Part B Breast\nprostheses reimbursement: <\/strong>Medicare\nPart B (Medical Insurance) covers some external breast prostheses (including a\npost-surgical bra) after a mastectomy. Part A covers surgically implanted\nbreast prostheses after a mastectomy if the surgery takes place in an inpatient\nsetting. Part B covers the surgery if it takes place in an outpatient setting.\nThe patient pays 20% of the Medicare-approved amount for the doctor’s services\nand the external breast prostheses. The Part B deductible applies.<\/p>\n\n\n\n Medicare reimburses for:<\/p>\n\n\n\n Cleft Lip Repair: <\/strong>State law requires reimbursement in 15 states\nfor cleft lip repair as reconstructive.<\/p>\n\n\n\n Liposuction <\/strong>as an adjunct to Abdominoplasty and\nPanniculetomy (Tummy Tuck):<\/p>\n\n\n\n Aetna Cosmetic Surgery Policy [CPB-0031]:<\/strong> liposuction when performed with a\npanniculectomy and also liposuction when performed with breast reconstruction\nafter a mastectomy and not lipedema is considered reconstructive <\/strong>and not cosmetic. Update due 1-9-2020.<\/p>\n\n\n\n Documentation must demonstrate to the medical insurance company the\npatient has completed conservative non-surgical treatment of lipedema without\nadequate relief of their lipedema symptoms.<\/p>\n\n\n\n Note that in addition to healthcare carrier policies, there are both\nfederal and state laws regulating reimbursement for certain procedures as\nreconstructive. Breast reconstruction is both a federal law and there are\nindividual state laws (requiring reimbursement). <\/p>\n","protected":false},"excerpt":{"rendered":" This is included more as a thought experiment. I don\u2019t know if the \u201ccomparable procedure\u201d argument would have any weight with an appeal review committee concerning reimbursement for liposuction for lipedema. I\u2019ve never tried this strategy. However, if you\u2019re working on your second or third-level appeal, it might be worth… Continue reading