What It Is
Plastic surgery to modify or reconstruct a part of the body, including cosmetic surgery and reconstructive surgery
What's Covered
Medicare Part A or a Medicare Part C plan covers inpatient costs, and Medicare Part B or a Medicare Part C plan covers doctors' charges and outpatient costs for plastic surgery that's considered reconstructive, in three situations:
To repair the body following an accidental injury
To improve the function of a body part that never developed or formed properly
To reconstruct one or both breasts following mastectomy
Neither Medicare Part A, Medicare Part B, nor a Medicare Part C plan covers plastic surgery that's solely for cosmetic purposes.
If you have a Medicare Part C Medicare Advantage plan: Co-payments and deductibles for Medicare Part C Medicare Advantage plans may be different from those for Medicare Part A or Part B. To find out whether your plan has different deductibles or co-payments for covered reconstructive surgery, contact the plan directly.
What Medicare Pays
Hospitalization: If you're admitted to the hospital for covered reconstructive surgery, you pay the Medicare Part A deductible of $1,068 before Medicare pays anything. After that, Medicare Part A pays according to its normal schedule of inpatient coverage and patient copayments. See What are Medicare Part A and Medicare Part B premiums, deductibles, and coinsurance amounts in 2009? Doctor and other outpatient care: For the doctors who perform covered reconstructive surgery, and for all related outpatient care not performed at a hospital outpatient department, Medicare Part B pays 80 percent of the amount approved by Medicare for those services.
Warning:** If the covered surgery is performed or related care provided in a hospital outpatient department, the patient may be responsible to the hospital for a co-payment above the Medicare-approved amount under Medicare Part B.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
Hello Anonymous, Thank you very much for your question. Unfortunately, we are unable to diagnose medical problems for our site members, or provide medical guidance online. In addition we do not have resources on specific doctors. While members of our community may respond to your question, we recommend that you contact a doctor offline regarding this medical issue. Take care -- Emily | Community Manager
I had implantsin 1995 and have a 3,000 dollars on scrow for a remuval. I had cancer (myeloma) a small tummor on my back disck (bone marrow) I had big fears of the removal, as I was getting kemo, my breast became harded and harded, they very painfull. I have being a surviver for seven years and I have made up my mined to have them removed. They are hard as a brick. I have medicade part A and B also Medicade. I live in south florida. Olease let me know of a Dr. who will work with me.
Hi theladymagic, Thank you very much for your comment. I am so sorry to hear about your situation, that must be very difficult. Unfortunately, we don't have any resources on plastic surgeons, but I certainly wish you the best of luck in locating one that can help you out. Take care. Emily | Community Manager
I was bitten by a brown recluse spider on my face, I was referred to a plastic surgeon, by my doctor. But his office will not deal with state funds. This is a need not a want, is there a PS in or near Charlotte,NC that will take Medicare to fix my face, or willing to do pro bono, or have a small, long payment plan?