ASPS Recommended Insurance Coverage Criteria
The American Society of Plastic Surgeons has developed a series of papers outlining the Society's position on recommended insurance coverage criteria for third-party payer coverage.
These papers are designed to assist third-party payers in addressing reimbursement issues for various "gray area" plastic surgery procedures, those that could be considered either cosmetic or reconstructive.
Cleft Lip and Palate Surgery
Posted in 2022
It is the position of the American Society of Plastic Surgeons that both initial and secondary procedures for treatment of cleft lip and palate birth defects should be compensable by third party payers, regardless of the patient's age.
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Nasal Surgery
Posted in 2021
Nasal surgery is considered reconstructive surgery and medically necessary to improve nasal airway function, treat anatomic abnormalities caused by birth defects or disease and revise structural deformities resulting from trauma.
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Reduction Mammaplasty
Posted in 2021
These policy recommendations are based on the evidence-based guideline for breast reduction.
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Blepharoplasty
Posted in 2020
These policy recommendations are based on the evidence-based companion guideline for blepharoplasty.
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Breast Implant-Associated Anaplastic Large Cell Lymphoma
Posted in 2020
These policy recommendations are based on the evidence-based companion guideline for BIA-ALCL.
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Panniculectomy
Posted in 2019
These policy recommendations are based on the evidence-based guideline for panniculectomy.
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Abdominoplasty
Posted in 2018
These policy recommendations are based on the evidence-based guideline for abdominoplasty.
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Breast Reconstruction for Deformities Unrelated to Cancer Treatment
Posted in 2018
These policy recommendations are based on the evidence-based guideline for breast reconstruction for deformities unrelated to cancer treatment.
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Reconstruction after Prophylactic Mastectomy
Posted in 2017
These policy recommendations are based on the evidence-based guideline for prophylactic mastectomy.
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Nerve Decompression for Migraine Surgery
Posted in 2017
These policy recommendations are based on the evidence-based companion guideline for migraine surgery.
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Skin Lesions
Posted in 2017
These policy recommendations are based on the evidence-based companion guideline for skin lesions.
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Surgical Treatment of Skin Redundancy for Obese and Massive Weight Loss Patients
Posted in 2017
These policy recommendations are based on the evidence-based companion guideline for skin redundancy.
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Breast Reconstruction Following Diagnosis & Treatment for Breast Cancer
Posted in 2016
These policy recommendations are based on the evidence-based guideline for breast reconstruction following diagnosis and treatment for breast cancer.
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Fat Grafting to the Breast
Posted in 2016
These policy recommendations are based on the companion guideline for Post-Mastectomy Fat Graft/Fat Transfer.
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Gynecomastia Surgery
Published in 2015
These policy recommendations are based on the evidence-based companion guideline for male breast reduction surgery.
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Ear Deformity Surgery
Published in 2015
These policy recommendations are based on the evidence-based companion guideline for ear deformity surgery.