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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.52 Panniculectomy and Abdominoplasty : 9.2.52.2 Abdominoplasty

9.2.52.2
An abdominoplasty (procedure code 15847) is a benefit for clients who are birth through 20 years of age and may be reimbursed with prior authorization for one of the following conditions:
Abdominoplasty is not a benefit when one of the following is the primary purpose:
To remove excess skin and fat and tighten abdominal wall from the middle and lower abdomen in order to contour and alter the appearance of the abdominal area to improve appearance.
Abdominoplasty may be prior authorized when the client meets all of the following criteria:
Letters with pertinent information from provider (when medical records are requested, a letter of support or explanation may be helpful, but alone will not be considered sufficient documentation to make a medical necessity determination)
Consideration of other abdominal diagnoses may be considered for prior authorization with the submission of additional supporting documentation that may include the following:
Letters with pertinent information from provider (when medical records are requested, a letter of support or explanation may be helpful, but alone will not be considered sufficient documentation to make a medical necessity determination)

Texas Medicaid & Healthcare Partnership
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