Medicare Coverage of Plastic Surgery

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.

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13 Comments So Far. Add Your Wisdom.

over 1 year ago

we recently found out that my sister has breast cancer ; she lives in gainesville ga and we are looking for a plastic surgeon for reconstructive surgury that accepts womens breast medicaid ! she has her mecectomy in a month. if anone knows of someone PLEASE send name and no. she does not need to b reminded she has no breast everyday when she takes a shower its not fair !

Anonymous said over 1 year ago

I have heavy upper eyelids that interfere with vision (especially at night). Does Medicare cover plastic surgery for this condition?

Anonymous said over 1 year ago

I had twin girls 42 years ago,they were over 15 lbs.which left me grossly deformed,I have massive skin that hangs,it gets raw underneath,sometimes bleeds and becomes infected,my abdomen and breasts hang and become red and raw from perspiration. I have stretch marks down into the pubic area which also hangs down. The tops of my legs,all the way around my hips into the lower back area,in addition to the abdomen and there any help from Medicare?

over 1 year ago

I had gastric bypass and my breasts are extremely flat and hang,i get a terrible raw rash under them iassume is a fungus,will mcu cover breast lifting

almost 2 years ago

Your blog gives the correct information but according to me this is not enough to explain your topic regarding plastic surgery.

about 2 years ago

I had umbellical surgery woth mesh and correction of diastatis recti. I believe strongly that they surgeon did something wrong bec immediatly the nextvday i was back in the hospital for extreme pain and body spasms so bad morphin would barely take the edge off.. which ive been told this surgery is rarely that painful and is usually treated with meds at home. At the er the bandages were removed and i immediately noticed a deformation on the right side of my belly amd much of the pin seemed to originate in or around that area...crippling pain. Still now i have this golfball sized lump there that seems numb at the skin but painful with any pressure and sometimes painful without any contact. It hurts to sleep on my stomach even or wear anything that touches it or wraps around it..ex high waist skirt. My question to you is if i require this to be fixed my a PS will that be covered if what i need to be done is due to the mistake of a prior covered procedure and is causing daily pain?? Plzz answer i really need the help its begining to become unbearable.

about 2 years ago

I have been living with HIV for 25 years. Because of HIV completions, I retired early from State service as a Legislative Analyst for DHCS due to complications of the HIV Virus and the toxic side effects caused by the from later and former. Fortunately, my HIV is, now, under great control--high t-cells and undetectable viral load. Hence, I want to resume my career interpreting, implementing, and monitoring Health Care Programs for the disadvantaged in California. Because of my strong work history with health legislation and a MA in Composition from Berkeley, I am unable to interview for a support staff positions with the State because I am considered over qualified because of my proven work history and education. Hence, I an only eligible for jobs analogous to my work history. Although I am now considered very healthy by my HIV physician and, regardless of how accomplished I am, I have been a top candidate in interviews, acing the interview and test process--but my restored face due to both wasting of bone-loss of my face due to the HIV Virus and HIV toxic medications literally preclude me from securing. Especially in this very tough job market, aside from excellent proven history and education, possessing the physical appearance a healthy ,vital, youthful youthful appearance is critical in securing work. I summary, I want to resume my career but my unattractive, wasted facial appearance is precluding securing work. In Northern California Are there and plastic surgeons who perform probono facial surgery for survivors of HIV/AIDS........or physicians who could provide facial surgery I could afford? Women who have lost their breasts, children with clef palates and many others with deformities often qualify for plastic surgery do to poor self esteem because of their appearance...........I am not exception and suffer from poor self esteem and, consequent, depression because of my inability to return to meaningful work. Please advise. Respectfully, Jerome Day in Northern California

about 2 years ago

I have been HIV + for over 20 years. One of the side effects of the meds is Lipodystrophy. It is in my neck, back of neck hump, and back. It is painful, uncomfortable to sit or sleep. Causes headaches, and back pain. I am getting disc deterioration. My Docs are all in support. I also suffer from depression because of it, and am getting treated for that also. I am on dissability so out of pocket would be pretty much impossible. Is it possible to get medicare to cover the expense?

over 2 years ago

Need Plastic Sergeon to remove grosss stomach overweight only in stomach area detracts from my apperance embarassing kindly send name and tele # for Riverhead,, NY area Randalll L. Hoops 631-276-5481

over 3 years ago

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

Anonymous said over 3 years ago

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.

over 3 years ago

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

over 3 years ago

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?


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