Cosmetic and Reconstructive Surgery
J15 · Effective May 28, 2023
5 active Medicare policies list 11921, and 19 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective May 28, 2023
J5 · Effective Nov 14, 2021
J8 · Effective Nov 14, 2021
J5 · Effective Jan 1, 2026
National · Effective Nov 27, 2025
19 policies from 11 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Sep 1, 2026 | Covered |
| Gender Affirming Interventions for Gender Dysphoria | Apr 1, 2026 | Covered |
| Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures | Jul 1, 2026 | Covered |
| Cosmetic and Reconstructive Services: Skin Related |
| Jan 6, 2026 |
| Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |
| Cosmetic and Reconstructive Procedures | Jun 1, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Not recorded | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Breast Reconstruction | Aug 3, 2026 | Covered with conditions |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 11921 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |