Skip to Content

  • Site Search

Panniculectomy Medical Necessity Criteria

Approved:  3/04
Reviewed:  3/06, 2/07, 2/08, 2/11, 1/12, 1/13, 3/14, 2/15,1/16, 1/17
Revised:  3/06, 6/07, 1/09, 3/10

 

Abdominoplasty is a surgical procedure performed to tighten loose anterior abdominal wall muscles and remove excess abdominal skin and fat.  Abdominoplasty, including diastasis recti repair, is considered a cosmetic procedure.

Panniculectomy may be performed for both medically necessary and cosmetic reasons.  The medical need for this procedure must be established by documenting that the enrollee has significant symptoms that cannot be adequately managed with more conservative or less invasive measures.

The following guidelines are used when determining the medical necessity of panniculectomy requests:

  1. A statement from the enrollee’s primary care physician recommending panniculectomy surgery.

  2. Photographs documenting that the panniculus hangs at or below the level of the pubis.

  3. Medical records from the enrollee’s family physician and other treating physicians documenting that the panniculus causes chronic rashes, abscesses, skin irritation, infection, chafing, or dermatitis occurring on opposed surfaces of the skin, that consistently recur over six (6) months of appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of 6 months, despite good hygiene practices. 

  4. Panniculectomy is requested following significant weight loss, documentation from the patient’s primary care physician indicating that the enrollee’s weight has remained stable for six (6) months is required.

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.