Trying to figure out what Medicare might cover is at times difficult especially when it comes to plastic surgery. It is hard from our end as well as Medicare payments are pretty low. We restrict access to certain services to keep from violating Medicare rules and also to keep within at least a narrow profit margin. Medicare services are already at a severe discount relative to our practice fee structure. Medicare does not pay much for materials used when surgery is performed in an office setting. This means sutures, medications, dressings, etc are "losses" revenue-wise when we operate in the office. We take this into account when deciding whether we can offer you office surgery. Sometimes we will need to take you to the hospital even to do fairly simple surgery for these reasons. Still we see a fair number of Medicare patients, as long as they are not members of Medicare HMOS as we are not providers for them. This practice takes care of more Medicare cancer patients that of any other local Board-certified plastic surgfeon. Of this we are certain.

Medicare historically has covered:
Reconstruction from skin cancer
Breast Cancer Reconstruction when a Mastectomy has been performed
Burn Reconstruction
Trauma Reconstruction

Medicare pays so poorly for breast reduction that we can no longer offer this service to our Medicare patients. The major exclusion for Medicare (like other insurance companies) is cosmetic surgery. We do not "test the limits" here. You will not get a tummy tuck on Medicare at least not in this practice.

We can remove skin cancers in the office but do not have "on demand" pathology for such cases. The re-operation rate in such case is 10-15%. We can also send patients for excision by a local dermatologist and do the reconstruction following. This has worked out pretty well.

Please note that we cannot guarantee that Medicare will cover any particular service. We only report here our experience as a Medicare provider. If you have questions on Medicare coverage you are advised to contact Medicare directly for clarification:

[Medicare.gov coverage section]