CurrentUnitedHealthcarePolicy CS203NM.C

Liposuction for Lipedema (for New Mexico Only)

UnitedHealthcare New Mexico medical policy defining coverage criteria for liposuction to treat lipedema, documentation requirements, listed applicable procedure and diagnosis codes, exclusions, and evidence/guideline background.

Policy Summary

PayerUnitedHealthcare

PolicyLiposuction for Lipedema (for New Mexico Only)

Policy CodePolicy CS203NM.C

Change TypeDocumentation and evidence updates

Effective DateJan 1, 2026

Next Review Date

Key ActionProvide documentation of lipedema diagnosis including specified clinical features and photographs documenting disproportional fat distribution consistent with diagnosis.

SourceLink

POLICY UPDATE CHANGES

Medical Records Documentation Used for Reviews: added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and that medical records documentation may be required but does not guarantee coverage.

Updated Clinical Evidence and References sections to reflect most current information.

3Primary CPT Codes Listed

2Diagnosis Codes Listed

>5000 ccVolume threshold for serial procedures