Is a Tummy Tuck covered by Medicare?

Question

What are the reasons a Tummy Tuck would be covered by Medicare? How do a person find out if they qualify? Do they call medicare or will their doctor find out for them?

Daniel Careaga, MD · Answer

Medicare will not cover an abdominoplasty... It is considered a cosmetic procedure.  The only abdominal contouring operation that Medicare covers is called a panniculectomy.  This involves excision of redundant abdominal skin without muscle tightening.  For this to be covered typically you have to have lost over 100 lbs under a Doctor's supervision or with bariatric surgery.

Thomas Trevisani, MD · Answer

No. This is a Cosmetic procedure that is not covered by insurance......................................

Gary Lawton, MD, FACS · Answer

The tummy tuck cosmetic procedure would not be covered.  You need to check with your plastic surgeon to see if you qualify for a medically necessary procedure.  Some of the conditions that are treated by similar procedures to a tummy tuck are hernias and rashes with chronic infection.  This is a decision for the surgeon who has examined you.

Kenneth Hughes, MD · Answer

Medicare will not cover this cosmetic procedure.Kenneth Hughes, MDLos Angeles, CA...................

Shim Ching, MD · Answer

Medicare will not cover a cosmetic procedure.  Tummy tucks are cosmetic surgery.   Medicare could cover a panniculectomy, but this is simply the removal of excess skin that is causing medical problems.  A tummy tuck is a completely different procedure.

Ronald Schuster, MD · Answer

Medicare does not cover tummy tucks, which are considered cosmetic procedures. Rarely, they will cover the removal of folds of skin if there is chronic irritation. But the results of these procedures do not leave you with the appearance of someone who has gotten a real tummy tuck.

Peter J. Capizzi, MD · Answer

Tummy tucks are cosmetic procedures and therefore never covered by Medicare.  Panniculectomies or removal of overhanging skin that causes open wounds can be covered at times, but this procedure is NOT a tummy tuck.

Humberto Palladino, MD, FACS · Answer

Medicare does not cover cosmetic procedures such as abdominoplasty. Some private insurances might cover correction of abdominal wall diastasis. Occasionally medicare will cover a dermolipectomy or removal of the overhanging skin.

Jourdan Gottlieb, MD · Answer

Tummy tuck is not covered by medicare.  The code used to bill a tummy tuck has no attached compensation for surgeon or surgicenter.Medicare may cover a panniculectomy, or excision of overhanging skin below the navel.  There must be medical indications, usually recurrent rashes requiring medical intervention.  But there is no way to find out in advance since Medicare does not offer pre-authorization.  And if Medicare denies the claim, you may find yourself with a bill greater than a full tummy would have cost in the first place. Many surgeons would not do these due to experience of being in the middle of a dispute between patient and Medicare. Hope that helps, all the best.

Alan M. Engler, MD, FACS (retired) · Answer

No.  A cosmetic procedure is not covered by Medicare.  Aesthetic procedures may be covered depending on the need for the procedure; for example, a burn scar revision following an injury.  But a tummy tuck is normally a cosmetic procedure and, as such, would be be covered.If there is a significant amount of excess skin and tissue below the belly button - to the extent that it causes pain, redness, irritation, etc - and only that area is being treated, then the procedure may be covered.  This, however, would be termed a panniculectomy, and getting it "covered" is something the patient would have to discuss with his or her plastic surgeon.I hope that this helps and good luck,Dr. Alan EnglerMember of RealSelf100

Is a Tummy Tuck covered by Medicare?

Answers (10)

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