Cosmetic Procedures and Medicare


New Port Richey & Gulf to Bay
Best answers
I have just heard from someone that a facility and provider are legally required to report all cosmetics procedures to Medicare, if the code is considered a cover code. All you would do is have the patient sign an ABN.

Example, A patient is scheduled for a cosmetic procedure. Patient signs an ABN and pays for their procedure. A claim is generated to Medicare, because the code is on their covered list. If Medicare decides this is medically necessary (Even with a V50.1 dx code) and pays the claim, we are to refund the patient. If they don't pay, we would keep the patients money due to the ABN.

Is that the way cosmetic procedures are to be done, if the patient has Medicare? Can someone provide me with official resources and references? Thank you for the help.