Cosmetic and Reconstructive Surgery
J15 · Effective May 28, 2023
20 active Medicare policies list 19316, and 24 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
J9 · Effective Jul 11, 2021
JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
J5 · Effective Nov 14, 2021
J8 · Effective Nov 14, 2021
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
24 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 19316 |
|---|---|---|
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Mastopexy | May 15, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Mastopexy |
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
JL · Effective Nov 17, 2025
National · Effective Jan 1, 2026
J9 · Effective Nov 17, 2025
J5 · Effective Jun 25, 2026
National · Effective Nov 27, 2025
National · Effective Oct 16, 2025
J6 · Effective Apr 1, 2026
National · Effective Oct 1, 2026
| May 15, 2026 |
| Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
|---|
| Policy | Effective | Status of 19316 |
|---|---|---|
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Mastopexy | May 15, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | Jan 1, 2026 | Covered |
| Mastopexy | May 15, 2026 | Covered |
| Reconstructive Breast Surgery | May 15, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Reduction | Nov 15, 2025 | Covered |
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Procedures | Sep 3, 2025 | Covered |
| Breast Reconstruction | Aug 3, 2026 | Covered with conditions |
| Policy | Effective | Status of 19316 |
|---|---|---|
| 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 19316 |
|---|---|---|
| Cosmetic and Reconstructive Procedures | Not recorded | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures | Jul 1, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 19316 |
|---|---|---|
| Breast Reconstruction | Jan 1, 2026 | Covered |