Cosmetic and Reconstructive Surgery
J15 · Effective May 28, 2023
6 active Medicare policies list 11954, and 22 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 Jun 25, 2026
National · Effective Nov 27, 2025
National · Effective Oct 1, 2026
22 policies from 8 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 11954 |
|---|---|---|
| Breast Reconstruction Following Mastectomy or Lumpectomy | Apr 15, 2026 | Not covered |
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Injectable Fillers for Head and Neck Conditions | Jun 15, 2026 | Not covered |
| Orthognathic Surgery | Oct 15, 2025 | Not covered |
| Policy | Effective | Status of 11954 |
|---|
| Adipose-derived Stem Cell Enrichment in Autologous Fat Grafting to the Breast | Feb 1, 2026 | Covered |
|---|---|---|
| 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 11954 |
|---|---|---|
| Autologous Adipose-derived Regenerative Cell Therapy | Jan 6, 2026 | Not covered |
| Autologous Fat Grafting and Injectable Soft Tissue Fillers | Jan 6, 2026 | Covered |
| Cosmetic and Reconstructive Services: Skin Related | Jan 6, 2026 | Covered |
| Policy | Effective | Status of 11954 |
|---|---|---|
| Fecal Incontinence | Aug 31, 2023 | Covered |
| Skin and Soft Tissue Substitutes | Feb 9, 2024 | Covered |
| Policy | Effective | Status of 11954 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 11954 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 11954 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 11954 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Jan 1, 2026 | Covered |
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |