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National Coverage Determination (NCD) for Plastic Surgery to Correct "Moon Face" (140.4)

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Benefit Category
No Benefit Category

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Indications and Limitations of Coverage

The cosmetic surgery exclusion precludes payment for any surgical procedure directed at improving appearance. The condition giving rise to the patient's preoperative appearance is generally not a consideration. The only exception to the exclusion is surgery for the prompt repair of an accidental injury or for the improvement of a malformed body member which coincidentally serves some cosmetic purpose. Since surgery to correct a condition of "moon face" which developed as a side effect of cortisone therapy does not meet the exception to the exclusion, it is not covered under Medicare (§1862(a)(10) of the Act).


Cross Reference
See the Medicare Benefit Policy Manual, Chapter 16, §120.
Transmittal Number

36

Revision History

5/1989 - Added statutory authority citation. Effective date NA. (TN 36)


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