Insurance pays for plastic surgery only when it treats a documented functional problem: a breast reduction for pain that has resisted treatment, a panniculectomy for a hanging fold that causes refractory skin infection, liposuction for lipedema, and reconstruction after mastectomy. None of the five insurers reviewed covers a tummy tuck or liposuction for shape. For a breast reduction at a body surface area of 1.50 m², the minimum tissue weight runs from 260 g per breast at Cigna, Anthem and BCBS of South Carolina to 385 g at Aetna.
- Tummy tuck
- Cosmetic at all fiveinsurer policies, 2026
- Breast reduction, BSA 1.50
- 260 g to 385 g per breastSchnur scale and Aetna Table 1, 2026
- Panniculectomy wait after bariatric surgery
- 12 to 18 monthsAetna counts from the weight plateau, 2026
- Medicare in South Carolina
- LCD L33428Palmetto GBA, revised 2021
The test every insurer uses
Aetna, Cigna, UnitedHealthcare, Anthem and BCBS of SC draw the same line. UHC’s MP.007.33 (June 1, 2026) calls a procedure reconstructive only if a documented abnormality causes a functional impairment and treatment is likely to restore function; everything else is cosmetic, and psychological distress over appearance “does not classify surgery” as reconstructive. Anthem warns that not every contract includes reconstructive benefits, and Cigna and UHC say the plan document overrides the policy. Expect to supply photographs, letters of medical necessity and chart records (Aetna CPB 0031).
What no insurer covers
- Tummy tuck. Cosmetic “for any indication” at Cigna and “for all applications” at BCBS of SC; diastasis recti repair is covered by none. See tummy tuck cost.
- Liposuction for shape. Cosmetic everywhere. Aetna lists buttock augmentation as cosmetic, and no policy reviewed covers a BBL or a mommy makeover.
- Breast lift for sagging. Cosmetic at Aetna, Anthem and Medicare. BCBS of SC may cover a lift on the healthy breast for symmetry after a medically necessary mastectomy.
Breast reduction: five insurers compared
| Insurer and policy | Symptoms and treatment | Minimum tissue at BSA 1.50 / 1.80 / 2.00 m² | At any BSA |
|---|---|---|---|
| Aetna CPB 0017 (reviewed March 12, 2026) | Two body areas, 1 year; 3-month treatment trial; mammogram at 50+ | 385 / 645 / 915 g from each breast | Over 1 kg per breast |
| Cigna 0152 (effective November 15, 2025) | One symptom unresponsive to medical management | 260 / 441 / 628 g, average per breast | Over 1 kg per breast |
| UnitedHealthcare MP.004.32 (June 1, 2026) | InterQual, not public | Not published | Not published |
| Anthem CG-SURG-71 (reviewed May 14, 2026) | 3 months of conservative treatment | 260 / 441 / 628 g from at least one breast | 1 kg from each breast |
| BCBS of SC CAM 70121 (reviewed August 18, 2026) | Symptoms 1 year; 3 months of treatment | 260 / 441 / 628 g from at least one breast | 1 kg from each breast |
Aetna asks for roughly 45 to 50% more tissue than the Schnur 22nd-percentile scale the others use, and from each breast. UHC says “Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the Women’s Health and Cancer Rights Act of 1998.” No insurer covers reduction by liposuction alone. Cigna’s revised 0152 (from November 15, 2026) adds 6 months of stable weight after major weight loss, including on GLP-1 drugs, and 18 months after bariatric surgery. See breast lift and reduction cost.
Panniculectomy and skin removal after weight loss
A panniculectomy removes a hanging apron of skin and fat without a tummy tuck’s muscle tightening. Every insurer covers it under criteria; UHC’s are InterQual and not public.
| Policy | Pannus | Skin problem | After bariatric surgery |
|---|---|---|---|
| Aetna CPB 0211 | Below the pubis | Intertrigo refractory over 3 months | 12 months after the weight plateau |
| Cigna 0027 | At or below the symphysis pubis | Refractory 3+ months, plus a functional deficit | 18 months and 6 months stable |
| Anthem CG-SURG-99 | Below the pubis | 3 months failed treatment, or walking difficulty | 18 months or 3 months stable |
| BCBS of SC CAM 108 | At or below the symphysis pubis | Refractory 3+ months, plus a functional deficit | 18 months or 3 months stable |
| Medicare, Palmetto L33428 | Below the pubis | Intertrigo over 3 months | 18 months; 3 to 6 months stable |
None covers it for back pain or appearance, or as an add-on to a hernia repair or hysterectomy that does not meet the criteria on its own. Arm, thigh and buttock lifts are cosmetic at Aetna; Cigna 0470 covers them with a functional deficit, 3 months of refractory skin infection, 6 months of stable weight and 18 months after bariatric surgery, and Anthem ANC.00009 for a significant functional impairment. See skin removal surgery cost.
Liposuction for lipedema
All five cover limb liposuction for lipedema under criteria, after at least 3 months of failed compression or manual lymph drainage. Aetna and Anthem also cover the trunk; Cigna 0531 and BCBS of SC CAM 253 do not.
When a cosmetic operation goes wrong
UHC pays to treat a complication of a non-covered service. An Anthem Virginia individual HMO contract (2023) excludes complications of cosmetic surgery, except heart attack, pulmonary embolism and thrombophlebitis. Aetna, Cigna and Anthem pay to remove an implant for listed complications such as rupture, but none pays to put a cosmetic implant back. Two complication policies, CosmetAssure and Aesthetisure, are available only through enrolled surgeons and cover 45 days; CosmetAssure’s standard limits are $5,000 a day inpatient for up to 45 days and $3,500 outpatient or emergency.
Reconstruction after mastectomy
The Women’s Health and Cancer Rights Act requires a plan that covers mastectomy to cover all stages of reconstruction, surgery on the other breast for symmetry, prostheses and complications including lymphedema, at ordinary deductibles. The Department of Labor: “Despite its name, nothing in the law limits WHCRA rights to cancer patients.” It reaches individual policies too, but does not require a plan to cover mastectomy (CMS). South Carolina adds a reconstruction mandate (Code 38-71-130) and a 48-hour minimum stay for insured coverage (38-71-125).
Medicare in South Carolina
Medicare.gov: “Medicare usually doesn’t cover cosmetic surgery unless you need it because of accidental injury or to improve the function of a malformed body part.” South Carolina’s local rule is Palmetto GBA’s LCD L33428 (revised July 29, 2021). It covers a breast reduction after 6 months of symptoms, with tissue amounts of 300 g, 400 g and 500 g per breast by body weight that it calls guidelines, “not rules.” A hospital outpatient panniculectomy has needed prior authorization since July 1, 2020, decided within 7 calendar days. Complications of cosmetic surgery may be covered after discharge.
South Carolina Medicaid
The SCDHHS Physicians Services Provider Manual (October 1, 2026) excludes cosmetic surgery, covers a medically necessary panniculectomy or breast reduction with prior authorization by the state’s QIO using InterQual criteria and photographs, and never covers augmentation. Your physician files the request. Most members are in one of five managed care plans, which decide their own authorizations:
- Healthy Blue publishes BCBS-style criteria: a year of symptoms, the Schnur scale (310 g per breast at BSA 1.60), and for panniculectomy 18 months after bariatric surgery or 3 months stable.
- Absolute Total Care requires, for panniculectomy, 6 months of stable weight and 18 months after bariatric surgery, and lists liposuction and abdominoplasty as cosmetic.
- Select Health names tummy tucks and liposuction as not covered.
- Humana Healthy Horizons says members “may NOT be eligible” for reduction “for any indications other than those listed,” and lists only symmetry after breast cancer surgery. That reads narrower than the state manual; ask Humana and SCDHHS.
- Molina had no usable policy document.
Under federal EPSDT rules, members under 21 are reviewed case by case for any medically necessary service.
Taxes, HSAs and FSAs
IRS Publication 502 (2025): “You generally can’t include in medical expenses the amount you pay for procedures such as face lifts, hair transplants, hair removal (electrolysis), and liposuction.” Reconstruction after a cancer mastectomy and repair of a deformity from an accident, a disfiguring disease or a congenital abnormality do count, above 7.5% of adjusted gross income if you itemize. HSA and FSA money follows the same definition (Publication 969). Financing is on how to pay less for plastic surgery.
Frequently asked questions
Does insurance cover breast reduction?
Often, if you meet the plan’s criteria: documented symptoms, failed treatment, photographs and a minimum tissue weight. Most UHC plans exclude it outside WHCRA.
Does insurance cover skin removal after weight loss?
A tummy tuck, no. A panniculectomy, yes under criteria at all five insurers, and arm or thigh lifts at Cigna and Anthem for a functional impairment.
Does South Carolina Medicaid cover breast reduction?
The state manual covers it when InterQual criteria are met, with prior authorization. Most members’ managed care plan decides, and Humana’s policy reads more narrowly.
Does Medicare cover a panniculectomy?
Yes, under Palmetto GBA’s criteria in South Carolina, with prior authorization in a hospital outpatient department.
Can I use my HSA for liposuction?
Not for liposuction done for shape; Publication 502 names it. Ask your plan administrator about surgery that treats a disease, such as lipedema.
Sources
- Aetna: CPB 0017, CPB 0211, CPB 0031, CPB 0142
- Cigna: 0152, 0152 revised, 0027, 0470, 0531, 0048
- UnitedHealthcare: MP.004.32, MP.014.28, MP.007.33, lipedema
- Anthem: CG-SURG-71, CG-SURG-99, ANC.00009, SURG.00023, Virginia EOC (2023)
- BCBS of SC: CAM 70121, CAM 108, CAM 079, CAM 253
- CosmetAssure, maximum limits page, 2026; Aesthetisure, patient FAQ, 2026
- Department of Labor, WHCRA (2018); CMS, WHCRA; SC Code 38-71
- Medicare: Medicare.gov, LCD L33428, outpatient prior authorization
- SC Medicaid: SCDHHS manual, managed care, Healthy Blue CAM 70121HB, CAM 108HB, Absolute Total Care CP.MP.109, CP.MP.31, Select Health manual, Humana HUM-2030-001, EPSDT
- IRS: Publication 502, Publication 969
Figures retrieved October 2, 2026. Insurer policies are reviewed at least yearly and are not contracts; your plan document governs. Body Sculpting Masters is a publication, not a practice.
