Clinical Policy: Cosmetic and Reconstructive Surgery
Defines medical necessity criteria for reconstructive surgery and exclusions for cosmetic surgery for Health Net (California), includes examples of covered reconstructive indications, not-covered cosmetic procedures, relevant CPT/HCPCS/ICD-10 codes, and references to state mandates and Medicare LCD L39051.
Annual review—References updated (10/25).
Added language to refer to California reconstructive surgery mandates and noted exceptions for gender dysphoria treatment (11/18 prior revision).
Removed nasal surgery and pectus excavatum sections from medically necessary section in 11/19 (these have InterQual criteria).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.