![]() The following surgeries and procedures are considered medically necessary when criteria are met. ![]() Aetna reserves the right to deny coverage for other procedures that are cosmetic and not medically necessary. Please note that, while this policy statement addresses many common procedures, it does not address all procedures that might be considered to be cosmetic surgery excluded from coverage. This policy statement supplements plan coverage language by identifying procedures that Aetna considers medically necessary despite cosmetic aspects, and other cosmetic procedures that Aetna considers not medically necessary. Please check benefit plan descriptions for details. ![]() Additionally, many Aetna plans specify that certain surgeries are not considered to be cosmetic (e.g., surgery to correct the result of injury, post-mastectomy breast reconstruction, breast augmentation to treat gender dysphoria, surgery needed to treat certain congenital defects such as cleft lip or cleft palate). IntroductionĪetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also improves or changes the appearance of a portion of the body. This Clinical Policy Bulletin addresses cosmetic surgery and procedures. Number: 0031 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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