Panniculectomy - JE Part A

General Documentation Requirements for Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy), and related services:

• Description of the pannus and the underlying skin
• Description of completed conservative treatment and results
• The medical records document (s) that the panniculus causes complicating factors such as inability to walk, chronic pain, chronic intertrigo, candidiasis, or tissue necrosis that consistently recurs over three months and is unresponsive to oral or topical medication (when applicable)
• Pre-operative photograph (if requested)
• Copies of consultations (when applicable)
• Related operative report(s) (when applicable)
• Any other pertinent information

Coverage Criteria

• LCD - Plastic Surgery (L35163)
• Billing and Coding Article - Plastic Surgery (A57221)

Codes

The Prior Authorization for Certain Hospital Outpatient Department Part B Associated Codes List is in Appendix B of the CMS OPD Operational Guide.

Resources

• Prior Authorization for Certain Hospital Outpatient Department (OPD) Services (CMS)
• Federal Register