Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesPlastic/Reconstructive SurgeryAmeriHealth Caritas LA Fat Grafting Update | OpenP…
    Ask Trek AI about this page
    CurrentAmeriHealth Caritas LouisianaPolicy CCP.1550

    Autologous Fat Grafting and Injectable Soft-Tissue Fillers

    Customize your policy alerts

    Sign up for amerihealthcaritaslouisiana Policy CCP.1550 alerts

    Get alerted when Policy CCP.1550 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This policy governs medical-necessity determinations for minimally manipulated autologous fat grafting and injectable soft-tissue fillers, including covered reconstructive and therapeutic indications such as post-mastectomy breast reconstruction, systemic sclerosis digital ulcers, and FDA-recognized fillers for HIV-associated facial lipoatrophy.

    Policy Summary
    PayerAmeriHealth Caritas Louisiana
    PolicyAutologous Fat Grafting and Injectable Soft-Tissue Fillers
    Policy CodePolicy CCP.1550
    Change TypeNo material clinical or coverage changes
    Effective DateOctober 1, 2025
    Last ReviewOct 1, 2025
    Next Review DateFebruary 1, 2027
    Key ActionFor systemic sclerosis digital ulcers, use autologous fat grafting adjunctively with systemic therapy to promote healing.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3Covered indication categories
    Not covered

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Other uses
    22 studiesBreast reconstruction evidence
    42 studiesSystemic sclerosis evidence

    Covered and Non-Covered Uses

    Covered autologous fat grafting

    Autologous fat grafting may be medically necessary when the patient has one of the following indications.

    Covered autologous fat grafting indications

    • Post-mastectomy breast reconstruction: Correction of contour irregularities and improvement of tissue quality after radiotherapy in post-mastectomy breast reconstruction.
    • Systemic sclerosis digital ulcers: Adjunctive treatment of digital ulcers associated with systemic sclerosis to promote healing.

      Must be combined with systemic therapy.

    Covered injectable soft-tissue fillers

    Injectable soft-tissue fillers may be medically necessary when all of the following apply.

    HIV-associated facial lipoatrophy

    • FDA-recognized agent: The injectable agent is recognized by the Food and Drug Administration, such as poly-L-lactic acid or calcium hydroxylapatite.

    Investigational and cosmetic uses

    Uses not specifically identified as medically necessary are considered investigational or cosmetic.

    Not medically necessary uses

    • Generalized chronic wound management: Autologous fat grafting for generalized chronic wounds outside systemic sclerosis digital ulcers.
    • Acne scar management: Injectable soft-tissue fillers for acne scars.
    • Cosmetic enhancement: Autologous fat grafting or injectable soft-tissue fillers used for general aesthetic enhancement or to alter normal anatomic variation related to aging.

    Vocal fold indications

    Vocal cord paralysis and glottic insufficiency are addressed under a separate payer policy.

    Separate policy applicability: Additional uses of autologous fat grafting and injectable soft-tissue fillers for vocal cord paralysis or glottic insufficiency are outlined in CCP.1157, Supraglottoplasty and laryngoplasty.

    Enriched or more-than-minimally manipulated fat products, including stromal vascular fraction and nanofat, are excluded from this policy. The policy addresses minimally manipulated autologous fat grafting.

    Medical-necessity determinations for medications are subject to the applicable state-approved pharmacy policy.

    All other uses of autologous fat grafting and injectable soft-tissue fillers that are not specifically identified as covered are considered investigational, not clinically proven, and not medically necessary.

    Autologous fat grafting for generalized chronic wound management outside systemic sclerosis digital ulcers is not medically necessary. The evidence for generalized wounds is heterogeneous and characterized by very low certainty.

    Injectable soft-tissue fillers for acne scar management are not medically necessary. The supporting evidence is heterogeneous and of low quality.

    Autologous fat grafting or injectable soft-tissue fillers used for general aesthetic enhancement or to alter normal anatomic variation related to aging are cosmetic and not medically necessary.

    Provider Guidance and Denial Risks

    Step Therapy

    Systemic Therapy Required

    For systemic sclerosis digital ulcers, autologous fat grafting is covered only as an adjunct to systemic therapy. Confirm and document that appropriate systemic therapy is being provided or has been attempted before requesting coverage.

    • Indication: digital ulcers associated with systemic sclerosis.
    • Systemic therapy must be used in combination with autologous fat grafting.
    • For medication medical-necessity determinations, refer to the applicable state-approved pharmacy policy.
    Denial Risk

    Unlisted or Investigational Indication

    Autologous fat grafting and injectable soft-tissue fillers used for indications not specifically identified as covered are considered investigational, not clinically proven, and not medically necessary. Additional uses for vocal cord paralysis or glottic insufficiency are addressed separately in CCP.1157 Supraglottoplasty and laryngoplasty.

    Clinical Background

    Autologous fat grafting is a surgical procedure that harvests an individual's own adipose tissue by liposuction, processes the lipoaspirate using minimally manipulative techniques such as centrifugation or filtration, and injects the processed fat into another anatomic site for reconstructive or therapeutic purposes. It may provide structural volume replacement and regenerative effects, including modulation of inflammation, promotion of angiogenesis, and scar-matrix remodeling. Injectable soft-tissue fillers are substances placed in dermal or subcutaneous tissue; common materials include hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and collagen. They may restore volume immediately or stimulate collagen production over time.

    Key Terms

    Autologous fat grafting
    DefinitionSurgical transplantation of an individual's own adipose tissue from one anatomical site to another for reconstructive or therapeutic purposes.
    Harvesting and processingAdipose tissue is harvested via liposuction and processed using minimally manipulative techniques before injection into the target area.
    Injectable soft-tissue fillers
    DefinitionSubstances injected into dermal or subcutaneous tissue.
    MechanismsPhysical fillers provide immediate volume restoration, while bio-stimulatory fillers stimulate natural collagen production, or neocollagenesis, over time.
    ExamplesCommon materials include hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and collagen.
    Policy Summary
    PayerAmeriHealth Caritas Louisiana
    PolicyAutologous Fat Grafting and Injectable Soft-Tissue Fillers
    Policy CodePolicy CCP.1550
    Change TypeNo material clinical or coverage changes
    Effective DateOctober 1, 2025
    Last ReviewOct 1, 2025
    Next Review DateFebruary 1, 2027
    Key ActionFor systemic sclerosis digital ulcers, use autologous fat grafting adjunctively with systemic therapy to promote healing.
    SourceLink
    On This Page
    Covered and Non-Covered UsesProvider Guidance and Denial RisksClinical BackgroundKey Terms
  1. Verify that the requested indication matches a specifically covered use before submitting.
  2. Expect denial for unlisted or investigational indications under this policy.
  3. Route vocal cord paralysis or glottic insufficiency requests to CCP.1157.
    4. Denial Risk

    Generalized Chronic Wounds Not Covered

    Do not submit autologous fat grafting for generalized chronic wound management outside systemic sclerosis digital ulcers as medically necessary under this policy. Such use is investigational and not clinically proven.

    • Applies to generalized chronic wounds that are not systemic sclerosis digital ulcers.
    • Current evidence is heterogeneous and of very low certainty.
    Denial Risk

    Acne Scar Treatment Not Covered

    Injectable soft-tissue fillers used for acne-scar management are considered investigational and not medically necessary under this policy.

    • Supporting evidence is heterogeneous and low quality.
    • Do not request coverage for fillers solely to treat acne scars.
    Denial Risk

    Cosmetic Use Not Covered

    Autologous fat grafting and injectable soft-tissue fillers are not medically necessary when used for general aesthetic enhancement or to alter normal anatomic variation related to aging.

    • Cosmetic use is excluded regardless of the product or technique used.
    • Do not submit age-related aesthetic enhancement as reconstructive or therapeutic treatment.
    Denial Risk

    Enriched Fat Products Out of Scope

    This policy addresses minimally manipulated autologous fat grafting only. Do not treat enriched or more-than-minimally manipulated fat products as covered autologous fat grafting under this policy.

    • Excluded products include stromal vascular fraction and nanofat.
    • Processing described in scope is limited to minimally manipulative techniques such as centrifugation or filtration.
    Minimally manipulated autologous fat grafting
    DefinitionAutologous fat grafting processed using minimally manipulative techniques without enrichment into stromal vascular fraction or nanofat.
    Processing methodsExamples of minimally manipulative processing techniques include centrifugation and filtration.
    Excluded productsEnriched products such as stromal vascular fraction or nanofat are excluded from this policy.
    HIV-associated facial lipoatrophy
    DefinitionLoss of facial volume associated with HIV treatment or disease, including volume loss related to antiretroviral therapy.
    Filler purposeFillers such as poly-L-lactic acid and calcium hydroxylapatite may restore lost facial volume and contour.
    Clinical purposeTreatment may reduce social stigma and improve quality of life.