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OPD Procedure: Panniculectomy

A pannus develops when there is extra skin and fat deposits in the abdominal area. It usually occurs in the lower abdomen. A panniculectomy is a surgical procedure to remove the pannus. Per Medicare rules and regulations, a panniculectomy performed for cosmetic reasons is not considered reasonable and medically necessary.

Medical Necessity

Services are considered reasonable and medically necessary in patients with the following conditions, which may include, but is not limited to:

  • Chronic intertrigo (dermatitis, skin infection and irritation)
  • Candidiasis (yeast infection)
  • Tissue necrosis
  • Ulcerations in the skin folds
  • Following significant weight loss:
    • Loss of 14 BMI points and BMI ≤ 30
    • 18 months following bariatric surgery where weight loss has been maintained for at least 6 months
  • Pannus grade 3 or higher when in conjunction with another surgery
  • Infections or other skin conditions consistently reoccurring over 3 months despite appropriate medical therapy
  • Complicating factors associated with the pannus such as inability to walk, chronic pain, ulceration in the skin folds, etc.
  • If necessary, in conjunction with another procedure when the adipose tissue is too great for the longest surgical tool to reach the dissection site

General Documentation Requirements

  • Current H&P, office visit note, or physician progress note
  • Description of the pannus and underlying skin
  • Description of conservative treatments tried for at least 3 months and the patient's responses
  • Documentation that the pannus is causing the chronic intertrigo and other skin related conditions
  • Documentation following significant weight loss
    • After bariatric surgery – relative operative reports, weight before and after surgery
    • Loss of BMI points and the patient's current BMI
    • Maintained weight loss for at least 6 months
  • Copies of consultations when applicable
  • Related operative reports when applicable
  • Documentation related to effects on ADLs
  • Any supporting photographs if applicable

Prior Auth Request Form

Coverage Criteria and Resources


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