Does Medicare Cover Laser Fat Removal?

Individuals considering aesthetic procedures like laser fat removal often wonder about Medicare coverage. Understanding Medicare’s policies is important, as its primary focus differs from purely cosmetic enhancements. This article clarifies how Medicare approaches coverage for laser fat removal and contrasts it with other weight management interventions.

Medicare’s General Coverage Rules

Medicare covers services deemed “medically necessary.” This means a service must be reasonable and necessary for diagnosing or treating an illness, injury, or condition, and meet accepted medical standards. Medicare Part B generally covers outpatient services. After meeting an annual deductible, Medicare Part B typically pays 80% of the approved amount for covered services, with the beneficiary responsible for the remaining 20%.

Coverage for Laser Fat Removal

Laser fat removal, often sought for aesthetic reasons, is not covered by Medicare. This procedure, which uses lasers to heat and remove fat, is considered cosmetic. Medicare policies state that cosmetic surgery is not covered if it is solely for improving appearance, as it does not meet Medicare’s “medically necessary” criteria. While Medicare may cover plastic surgery to improve the functioning of a malformed body part, these exceptions do not apply to elective procedures like laser fat removal. Individuals considering laser fat removal should anticipate being fully responsible for the cost.

Medically Necessary Weight Management Procedures

While cosmetic fat removal procedures are not covered, Medicare provides coverage for certain medically necessary weight management interventions. For individuals with morbid obesity, Medicare may cover specific bariatric surgical procedures, such as gastric bypass surgery and laparoscopic banding surgery; to qualify, individuals typically must have a Body Mass Index (BMI) of 35 or higher and at least one obesity-related health condition, such as type 2 diabetes. Medicare also covers Intensive Behavioral Therapy (IBT) for obesity for beneficiaries with a BMI of 30 or higher. This therapy includes an initial assessment, nutritional evaluation, and ongoing counseling to promote weight loss through dietary changes and exercise, and these services must be provided by a qualified primary care physician or practitioner in a primary care setting. Medicare covers a structured schedule of sessions.

Paying for Services Not Covered by Medicare

When Medicare does not cover a service, the individual is responsible for the entire cost. Providers may issue an Advance Beneficiary Notice of Non-coverage (ABN) to inform patients that Medicare is unlikely to cover a service and that the patient will be financially responsible. If an ABN is not provided when required, the provider may not be able to bill the patient for the service. Individuals have several options for covering the costs of non-covered procedures, including paying out-of-pocket with savings, personal loans, medical credit cards, or utilizing existing credit cards. Some providers may also offer in-house payment plans.