Medicare Coverage and Plastic Surgery

Trying to figure out what Medicare might cover is at times difficult especially when it comes to plastic surgery. We restrict access to certain services to keep from violating Medicare rules. Medicare does not pay much for materials used when surgery is performed in an office setting. This means sutures, medications, dressings, etc are "losses" revenue-wise when we operate in the office. We take this into account when deciding whether we can offer you office surgery. Sometimes we will need to take you to the hospital or a Surgicenter for these reasons. Still we see a fair number of Medicare patients, as long as they are not members of Medicare HMOS. This practice takes care of more Medicare cancer patients that of any other local Board-certified plastic surgeon.

Medicare historically has covered:
Skin Cancer
Breast Cancer Reconstruction when a Mastectomy has been performed
Burn Reconstruction
Trauma Reconstruction

Medicare pays so poorly for breast reduction that we can no longer offer this service to our Medicare patients. The major exclusion for Medicare (like other insurance companies) is cosmetic surgery. We do not "test the limits" here. You will not get a tummy tuck on Medicare at least not in this practice.

We can remove skin cancers and reconstruct breasts after breast cancer with Medicare. Much of this work is performed as an outpatient.

Please note that we cannot guarantee that Medicare will cover any particular service, but do try hard to stay within their policy. If you have specific questions on your Medicare coverage you are advised to contact Medicare directly for clarification:

[Medicare.gov coverage section]