Navigating insurance coverage for lipedema surgery can feel overwhelming. Fortunately, growing awareness of lipedema as a legitimate medical condition has led many insurance providers to begin covering treatment. Below, Dr. Thomas Wright and the Lipedema Surgical Solutions team answer the most common questions about lipedema surgery coverage, costs, and how to work with your insurance company.
1. Is lipedema surgery covered by insurance?
In some cases, yes, lipedema surgery can be covered by insurance when it’s deemed medically necessary. However, many insurance plans exclude surgical treatment for lipedema and some insurance companies offer unreasonably low payment that does not even cover the cost of the supplies for the surgery. While coverage varies by state and provider, increasing medical recognition of lipedema as a chronic fat disorder has led some insurers to include it under reconstructive or medically essential procedures rather than cosmetic care.
Dr. Wright’s team assists patients in documenting medical necessity through diagnostic codes, symptom records, and imaging to help secure coverage.
Learn more about insurance coverage here.
2. What makes lipedema surgery “medically necessary”?
To qualify for coverage, your provider must determine that lipedema surgery is necessary to improve health, mobility, and quality of life, not for cosmetic purposes.
Documentation often includes:
- A formal lipedema diagnosis.
- Records of conservative therapy attempts (compression, diet, exercise).
- Evidence of pain, swelling, or mobility limitation.
Once medical necessity is established, your insurance provider is more likely to authorize partial or full coverage.
3. What is the diagnostic codes for lipedema?
Proper coding is crucial for approval. Lipedema reduction surgery is typically billed using CPT and ICD-10 codes that differentiate medical treatment from cosmetic procedures.
Examples include:
- ICD-10 Codes that can be used to code Lipedema:
- E88.20 (Lipomatosis, unspecified).
- R60.9 (Edema, unspecified) that crosswalks to lipedema
- Dr. Herbst with the help of Dr Wright and other lipedema specialists have submitted a proposal to the CDC to add specific code for lipedema. If approved, it will be E88.21, E88.22, and E88.23.
Each insurance plan may require specific documentation. Dr. Wright’s team works directly with patients and insurers to ensure accurate and compliant billing.
Review detailed insurance codes here.
4. What are the CPT codes for lipedema surgery?
Currently, the insurers will only accept cosmetic liposuction codes for lipedema surgery. These codes are wholly inappropriate.
- CPT Codes for Lipedema Surgery:
- 15877,15878, and 15879
Suction lipectomy does not properly describe this procedure. The purpose of this is not for cosmetic improvement but to reduce Lipedema fat with subsequent improvement for gait, mobility, and lymphatic function. Lipedema patients have impaired lymphatics and extra care must be taken to avoid primary lymphatic collecting ducts using specialized longitudinal surgical technique to avoid transecting lymphatic structures.
5. Which insurance companies cover lipedema surgery?
Several major insurance carriers now recognize lipedema surgery as medically necessary, including:
- Aetna – Covers lipedema reduction when conservative treatments fail and symptoms impair daily function. Learn more about Aetna’s policy.
- Anthem Blue Cross Blue Shield – May cover when detailed documentation supports medical necessity. Read about Anthem coverage.
- Cigna – Evaluates claims individually, often requiring evidence of functional improvement after surgery. More on Cigna.
- Tricare – Offers coverage for military members and dependents under specific conditions. See Tricare details.
- UnitedHealthcare – Reviews claims based on symptom severity and prior conservative care. Learn more about UHC.
6. What if my insurance denies my lipedema surgery claim?
Insurance denials are common initially, but they can often be successfully appealed. Dr. Wright’s team helps patients prepare appeal letters with supporting documents such as:
- Detailed physician notes and photographs.
- Diagnostic imaging.
- Evidence of medical necessity and prior treatments.
Persistence and thorough documentation significantly increase approval chances.
Learn more about navigating appeals and coverage here.
7. How much does lipedema surgery cost without insurance?
Costs depend on the extent of disease, number of areas treated, and number of sessions required. Patients typically undergo multiple staged procedures for safety and best results.
Without insurance, the cost may range from several thousand to tens of thousands of dollars. Dr. Wright’s team provides transparent estimates and helps patients explore payment options.
Learn more about costs and options here.
8. What payment options exist if insurance won’t cover surgery?
For patients without coverage, there are several alternatives:
- Flexible payment plans through the surgical practice.
- Medical financing with low-interest healthcare loans.
- Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) for tax-free payments.
- Staged procedures to spread out costs over time.
These options allow patients to move forward with treatment while managing expenses effectively.
Explore payment and financing options here.
9. Does Medicare cover lipedema surgery?
Currently, Medicare coverage for lipedema surgery varies depending on region and medical justification. Some cases may be approved when strong documentation of medical necessity and symptom impairment is provided. Dr. Wright’s office assists Medicare patients in submitting the necessary pre-authorization materials.
10. How can I improve my chances of getting insurance approval?
To strengthen your claim:
- Obtain a formal diagnosis of lipedema from a qualified physician.
- Document pain, swelling, or impaired function.
- Keep a record of all conservative treatments attempted.
- Include a letter of medical necessity from your surgeon.
Dr. Wright’s administrative team has extensive experience helping patients prepare documentation for successful insurance approvals.
11. Why are more people talking about insurance coverage for lipedema surgery?
Awareness of lipedema as a medical, not cosmetic, condition has grown significantly. Research now shows that surgical removal of diseased fat improves pain, function, and quality of life, leading major insurers to update their policies. Advocacy by physicians, patient groups, and organizations has helped push insurers to recognize the condition’s impact and necessity for coverage. The American Lipedema Association has made efforts to improve awareness and surgical coverage for lipedema. To learn more about their advocacy and consider joining, visit their website here.
Learn more about coverage trends and medical recognition here.
12. Will Dr. Wright’s team help me file an insurance claim?
Yes. Lipedema Surgical Solutions offers comprehensive support throughout the insurance process, from diagnosis coding and pre-authorization to appeals and documentation. The team ensures patients have the strongest possible case for approval, whether working with Aetna, Anthem, Cigna, Tricare, or UnitedHealthcare.
Contact the office for insurance guidance here.
Still unsure about your insurance coverage?
Dr. Wright’s experienced team can review your insurance plan, help document medical necessity, and assist you through the approval or appeal process.
