Does Medicare Cover Panniculectomy?

A panniculectomy, also known as skin removal surgery, removes excess skin that is left over from weight loss.

It is an invasive surgical treatment that aims to remove large amounts of excess skin on the lower part of the belly. Panniculectomies can be considered essential medical procedures because large amounts of excess skin may cause rashes, infections, and ulcers if they are not removed.

If this is a treatment you are thinking about getting, a common question you likely have is “does Medicare cover panniculectomy?”

In this article, we answer that question in clear, plain English. You will also find the average costs of panniculectomy if you have to pay for it yourself.

Does Medicare Cover Panniculectomy?

The short answer is yes. Medicare will cover the cost of panniculectomy. But that is not a guarantee. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your panniculectomy. Let’s look at what these conditions are below for different type of Medicare.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for a panniculectomy. Part A & B of Medicare generally do not provide coverage for cosmetic surgeries.

However, there are a few situations where these cosmetic surgeries may be covered. And a panniculectomy is one of those situations where getting coverage may be possible through Medicare.

There are a few requirements you’ll have to meet in order for Medicare to cover it. A big factor is that Original Medicare will only provide coverage for your panniculectomy if it is considered medically necessary.

The operation must be ordered by your healthcare provider for Original Medicare to provide coverage. Additionally you must also meet these requirements:

Maintain a stable weight for 6-months before surgery
Have a skin condition that threatens the health of your skin
Have excess skin that impacts daily movement
Your BMI must drop at least 5 points

Part A Coverage for Panniculectomy

Coverage for panniculectomy is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment each day. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will pay for a high daily copayment.

Part B Coverage for Panniculectomy

On the other hand, coverage for panniculectomy is provided by Medicare Part B when it takes place in an outpatient setting.

Once approved, Medicare Part B covers 80 percent of the costs of panniculectomy. You will pay for the remaining 20 percent.

Part C Coverage for Panniculectomy

Medicare Advantage plans (Medicare Part C) also provides coverage for panniculectomy. They cover everything Original Medicare covers – it’s required that Part C plans do. But they will offer additional benefits as well. The specifics of what a plan covers and what the out of pocket costs will be for that coverage will vary from plan to plan.

In some cases, you may pay the full cost first then get a reimbursement.

How Much Does A Panniculectomy Cost?

A skin removal surgery can cost somewhere between $8,000 to $15,000 if you have to pay for it yourself. That cost may only be just a portion of the total cost and will not include other costs such as anesthesia and hospital care.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.