Both Tummy Tuck and Male Breast Reduction are typically cosmetic (not medically necessary) procedures. These procedures may become medically indicated (either necessary, recommended, or medically appropriate) when: There is significant pain that may be improved, such as with a large hanging area of excess skin A hernia or severe loss of support of the abdominal muscles is present Excess skin is causing problems with rashes, irritation or infection (or perhaps pain) True feminization of the male breast shape that causes significant psychological disturbance Good News / Bad News The bad news is that medically indicated does not mean that an insurance company will pay for a procedure (as more often than not they will not pay or reimburse these procedures). The good news is many people are able to use flexible spending account or health savings account funds for a medically indicated procedure, even when medical insurance does not provide coverage. Hope this helps, Nick Slenkovich, MD FACS
Until about 10 years ago, insurers would consider payment for gynecomastia surgery. They have implemented more restrictive guidelines and the only basis for coverage would be genetic markers establishing high risk for breast cancer. The code for the surgery is mastectomy for gynecomastia. Barring this, the surgery, whether resection of glandular tissue or liposuction, would be considered cosmetic. Tummy tuck is also subject to more restrictions. A ventral hernia established by an MRI would be covered but the cost of this is minimal when compared with the tummy tuck. After bariatric surgery, some carriers will cover excision of the panniculus, or hanging apron of abdominal skin, but only upon documentation that rashes have been medically treated and are intractable.
