What kind of people are ideal candidates for a panniculectomy?
- You experience rashes or infections underneath the hanging fold of skin that are reoccurring or persistent.
Do insurance companies pay for a Panniculectomy?
Excess skin around the stomach is common in people who have lost a lot of weight, and it can cause skin rashes, irrational behavior, discomfort, and other issues. This is referred to as the pannus.
Many patients who have lost weight through lap band surgery, gastric bypass, or natural means consult with plastic surgeons to discuss their alternatives for resolving the issue.
A panniculectomy is a surgical treatment that removes excess skin from the pannus, which is located around the midsection. The pannus usually stretches from the abdomen to the back, causing skin irritation and other issues.
Making an incision similar to a stomach tuck and extending it around to the rear of the body as far as the excess skin occurs, the pannus is removed. This technique is done as an outpatient procedure with general anesthesia administered by a board-certified anesthesiologist. It’s frequently combined with other body lift treatments like a breast lift, breast reduction, or thigh lift.
PANNICULECTOMY VS. TUMMY TUCK
Both a panniculectomy and a tummy tuck are treatments that remove extra skin from the mid-section in order to obtain a flatter abdomen. A belly tuck, on the other hand, targets muscular laxity (diastasis), whereas a panniculectomy tackles solely the extra skin and tissue of the pannus. Your plastic surgeon will discuss which operation is ideal for you based on your objectives. Patients who have lost a lot of weight may need a panniculectomy first, then a stomach tuck 6 months to a year later to tighten the muscles.
Panniculectomy covered by insurance
Panniculectomy surgery is often reimbursed by insurance. Insurance companies frequently require documentation from medical professionals relating to weight reduction and/or weight loss surgery, skin irritability, or other disorders that affect daily living in order to qualify. In order to authorize the operation, most insurance companies also want images prior to the procedure.
PPO insurance is accepted by the board certified plastic surgeons at California Surgical Institute. Please complete the form below to receive a free insurance verification to see if you are eligible for panniculectomy with insurance and what type of copay you will have.
Why is a Panniculectomy medically necessary?
To minimize the panniculus, surgery called panniculectomy may be necessary. The excess skin and fat that hangs over the abdomen are removed during surgery. If the panniculus interferes with a person’s daily activities (ADLs) and/or causes serious skin diseases that do not respond to medical therapy, it may be suggested.
Does Blue Cross Blue Shield Federal cover Panniculectomy?
Unless the clinical conditions listed above are met, panniculectomy is not considered medically necessary. For the treatment of back discomfort, a panniculectomy or abdominoplasty, with or without diastasis recti correction, is not regarded medically required.
Do you have to lose weight to get a Panniculectomy?
Following bariatric surgery, panniculectomies are commonly performed on adults and, in certain situations, teenagers. 3 Before having a panniculectomy, you should be at a steady weight for at least six months.
Does UPMC cover a Panniculectomy?
Body contouring is usually not covered by health insurance, however there are exceptions.
Insurance companies frequently need documentation that the operation is medically required to avoid or alleviate difficulties.
- People with a big apron of skin who have a persistent rash despite using prescription creams may benefit from a panniculectomy.
- Breast reduction is for women who have enormous, heavy breasts that cause upper back pain, grooving in their bra straps, and a severe rash.
We will work with your insurer to obtain any available coverage and will assist you in exploring all alternative financing possibilities.
How much is a Panniculectomy?
- After decreasing weight, panniculectomies and tummy tucks are done to remove extra skin around the lower stomach.
- A panniculectomy is considered a medical need after a large amount of weight loss, but a stomach tuck is a cosmetic treatment.
Safety
- Pain and numbness are common side effects of both surgeries. Scarring is also a possibility, though it will fade over several months.
- Infection, severe pain and numbness, and bleeding are all rare consequences.
Convenience
- Both treatments are invasive surgeries that necessitate extensive planning and post-operative care.
- Finding a board-certified surgeon with substantial experience in each treatment is critical.
Cost
- A panniculectomy is more expensive than a stomach tuck, although medical insurance generally covers treatment. The price tag can range from $8,000 to $15,000, without including anesthesia and other fees.
- The cost of a belly tuck is less, but it is not covered by insurance. The average cost of this elective treatment is $6,200.
Efficacy
- Tummy tucks and panniculectomies have equal success rates. The objective is to decrease weight prior to surgery, as weight maintenance is critical to the success of your treatment.
Does Keystone first cover Panniculectomy?
When all of the above criteria are met, and there is photographic documentation (with member standing) of at least a Grade 2 panniculus that hangs to or below the level of the pubis, Keystone First considers panniculectomy after massive weight loss to be clinically proven and, thus, medically necessary.
What does your BMI have to be for a Panniculectomy?
The surgical treatments panniculectomy and abdominoplasty are discussed in this text, as well as when they are regarded medically required, not medically necessary, and cosmetic.
Procedures are considered medically necessary in this article if there is a severe functional impairment AND the procedure can be reasonably expected to improve that impairment.
Procedures are deemed cosmetic in this article when they are designed to change a physical appearance that would be considered within normal human anatomic variation. Cosmetic services are sometimes defined as those whose primary goal is to maintain or improve one’s looks.
- For those who match the following requirements, a panniculectomy is considered medically necessary:
- The panniculus hangs below the pubis (as evidenced by pictures); and
- for a period of three months, there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (such as dressing changes; topical, oral, or systemic antibiotics, corticosteroids, or antifungals); or
- There has been observed difficulty ambulating and interfering with daily activities;
- notwithstanding significant* weight loss that has been steady for at least 3 months or well-documented attempts at weight loss (medically supervised diet or bariatric surgery) that have failed; and
- If the person has undergone bariatric surgery, he or she must be at least 18 months post-op or have maintained a stable weight for at least three months.
*Significant weight loss is determined by the individual’s clinical conditions and may be noted if the person:
- Has lost at least 40% of the excess body weight that existed before to the individual’s weight loss program or surgical intervention.
- When needed for exposure in unusual conditions, a panniculectomy is regarded medically necessary as an adjuvant to a medically necessary procedure.
- When the above conditions aren’t met, a panniculectomy isn’t regarded medically required.
- Unless the conditions above are met, panniculectomy is not deemed medically required as an adjuvant to other medically necessary surgeries, such as hysterectomy or incisional or ventral hernia repair.
- For the treatment of back discomfort, a panniculectomy or abdominoplasty, with or without diastasis recti correction, is not regarded medically required.
- When done to remove extra abdominal fat, liposuction is considered aesthetic rather than medically required.
- When extra skin or fat is removed along with or without tightening of the underlying muscles, abdominoplasty is deemed cosmetic and not medically required.
- PI Blomfield, T Le, DG Allen, and RS Planner. A beneficial method for obese patients undergoing gynecological surgery is panniculectomy. Gynecol Oncol, vol. 70, no. 1, pp. 80-86, 1998.
- Surgical therapy of incisional hernia. Br J Surg. 2002; 89(5):534-545. Cassar K, Munro A.
- MR Coriddi, PF Koltz, R Chen, and JA Gusenoff. Changes in quality of life and functional status after abdominal contouring in those who have lost a lot of weight. 2011; 128(2):520-526 in Plast Reconstr Surg.
- JP Fischer, CT Tuggle, AM Wes, and SJ Lovach. An investigation of the ACS-NSQIP database found that concurrent panniculectomy with open ventral hernia repair carries a higher risk than ventral hernia repair. 67(5):693-701 in J Plast Recontr Aesthet Surg.
- KC Harth, JA Blatnik, and MJ Rosen. Is panniculectomy beneficial in the treatment of massive ventral hernias in morbidly obese patients? 201(3):396-400 in American Journal of Surgery, 2011.
- Panniculectomy during gynecologic surgery in morbidly obese individuals. Hopkins MP, Shriner AM, Parker MG, Scott L. Am J Obstet Gynecol, 182(6), 1502-1505, 2000.
- Ventral hernia repair with concomitant panniculectomy, Hughes KC. Ann Surg., 62(8), 678-681, 1996.
- BB Massenburg, P Sanati-Mehrizy, EM Jablonka, and PJ Taub. Abdominoplasty readmission risk factors and poor outcomes 2015; 136(5):968-977 in Plast Reconstr Surg.
- A. Matarasso, S. G. Wallach, M. Rankin, and R. D. Galiano. A review of early and late reoperative surgery for secondary abdominal contour surgery. 115(2):627-632 in Plast Reconstr Surg, 2005.
- Abdominal surgery in individuals with extreme morbid obesity, Matory WE, O’Sullivan J, Fudem G, Dunn R. 1994; 94(7):976-987 in Plast Reconstr Surg.
- FX Nahas, SM Augusto, and C Ghelfond Is it necessary to correct diastasis recti? 1997; 21(4):285-289 in Aesth Plas Surg.
- Panniculectomy in morbidly obese gynecologic oncology patients. Pearl ML, Valea FA, Disilvestro PA, Chalas E. Int J Surg Investig, 2(1), 59-64, 2000.
- Panniculectomy to enable gynecologic surgery in morbidly obese women, Obstet Gynecol. 1999 94(4):528-531. Powell JL. Panniculectomy to assist gynecologic surgery in morbidly obese women, Obstet Gynecol. 1999 94(4):528-531.
- Perioperative care of the post-gastric-bypass patient presenting for body contour surgery. Rubin JP, Nguyen V, Schwentker A. 31(4):601-610 in Clin Plast Surg, 2004.
- T. Staalesen, M. F. Olsén, and A. Elander. The impact of abdominoplasty and rectus fascia plication on post-bariatric surgery patients’ health-related quality of life. 136(6):750e-761e in Plast Reconstr Surg, 2015.
- H. Buchwald; Panel of the Consensus Conference. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers, according to a consensus conference statement. 2005; 1(3):371-381 in Surg Obes Relat Dis.
- The National Institutes of Health (NIH) is a federal agency that researches The National Heart, Lung, and Blood Institute is a federal agency that studies the heart, lungs, and blood. Calculate your BMI. Visit https://www.nhlbi.nih.gov/health/educational/lose wt/BMI/bmicalc.htm for more information. On the 28th of December, 2020, I was able to get a hold of some information
- The National Library of Medicine is a government-run medical library. Diastasis recti is a medical term that refers to a separation of the abdominal muscles. http://www.nlm.nih.gov/medlineplus/ency/article/001602.htm is a good place to start. On the 28th of December, 2020, I was able to get a hold of some information
Review by the Medical Policy and Technology Assessment Committee (MPTAC). In the Description section, I updated the MN definition text. Discussion/General Information, References, and Website sections have all been updated. The Coding part has been restructured.
Review of the MPTAC. The first draft of the document. SURG.00048 Panniculectomy and Abdominoplasty’s content has been moved to a new clinical utilization management guideline paper with the same name. (1) changed bullet “A” to state that liposuction is considered aesthetic and not medically required when done to remove excess abdominal fat; (2) revised bullet “C” by eliminating the phrases “for all indications.”