Conditions for reimbursement of plastic & reconstructive surgery by social security

Reimbursement of cosmetic, plastic and reconstructive surgery procedure may be supported in whole or in part by social security - health insurance (in France). Find below the list of plastic and reconstructive surgery procedures that can be covered totally or partially by the CPAM (Caisse Primaire d’Assurance Maladie).

Dr. Kron exercices as a plastic surgeon in the conventional sector with free rates (sector 2). The prices of a surgery will be communicated in writing at the end of the consultation with a notice of additional fees, not covered by Social Security.

Reimbursement of rhinoplasty

Rhinoplasty or septoplasty can be reimbursed with the prior approval of Health Insurance if there are documented functional disorders, whether the trouble is congenital or caused by an injury.

Surgery for congenital malformations can also be managed after prior approval by the Social Security (CPAM).

In the treatment of respiratory disorders caused by septal deviation, the demand for aesthetic rhinoplasty associated with septoplasty is considered a pure aesthetic act. As such, it can not be refunded and will be subject to a complementary aesthetic rate.

Reimbursement of surgery of the prominent ears

Prominent ears treatment correction is systematically refunded for children who are embarrassed during his social life, especially at school.

For adults, the deformity must lead to significant social discomfort confirmed by a medical certificate from a psychiatrist or by evidence of a disturbing resonance on a professional level. If the request is purely aesthetic, the management of an otoplasty by social security is not possible.

The correction of prominent ears with earFold implants can also be supported by social security and mutual health-insurance providers. Only the procedure (performed directly in the office) is reimbursed, not the cost of the implants themselves (around 1000 € TTC per implant).

Reimbursement of eyelid surgery

The dermatochalasis of the upper eyelid is covered by social security (CPAM) only if there is a superior amputation of the visual field confirmed after a ophthalmological examination.

Reimbursement of breast reconstruction and breast ptosis correction

Breast reconstruction after breast cancer is managed without prior social security approval except for reconstruction using implant.

Breast reduction can only be reimbursed if the resection is at least 300 g per breast. Back pain or psychological repercussions can only be evoked from this minimum weight. This act is not subject to prior agreement.

Breast ptosis correction is never reimbursed even after multiple pregnancies, massive weight loss or bariatric surgery (bodylift).

The correction of significant asymmetry by unilateral reduction surgery (without intervening on the contralateral breast) is supported without prior agreement.

The placement of prosthetic implants outside the oncological reconstruction can be supported in certain pathologies, after obtaining a prior agreement from the social security:

  • bilateral breast agenesis
  • severe bilateral hypoplasia ("man's thorax"),
  • severe congenital breast asymmetry malformative syndrome (tuberous breast and Poland's syndrome)

Breast implant removal can be reimbursed after obtaining a prior agreement for PIP implants. If at the same time the ptosis is corrected or new implants are placed, this complementary act is not reimbursed by the social security and is the subject of a complementary fee.

Reimbursement of abdominal surgeries

The correction of an abdomen (abdominoplasty) damaged by one or more pregnancies, even twin, is only supported if there is an umbilical hernia or anterior abdominal hernia. The reimbursement of this reconstructive surgery act does not require prior agreement. In this case, only the treatment of the hernia that is supported, the purely aesthetic part of the procedure is the subject of a additional fee.

The reduction of the "abdominal apron" is covered by social security only if it partially covers the pubis. This procedure can only be performed after major weight loss or as a result of bariatric surgery. Reimbursement requires prior agreement and photographic evidence.

The reimbursement of acts of recovery of pathological abdominal scars (reconstructive surgery), adherents, sequelae of previous interventions agreed, is supported. These acts do not require prior approval from the CPAM.

Liposuction of the abdomen can be managed without prior agreement in the context of lipomatosis Launois-Bensaude or severe lypodystrophy consecutive to particular therapeutic indications (antiretroviral treatment).

Restorative limb surgery

Dermolipectomy of the limbs (arm lift or thigh lift) can be reimbursed after prior agreement following a surgery such as bariatric surgery or following major weight loss.

The request for prior agreement from Social Security: According to CPAM - health insurance reglementation:

The reimbursement by the social security of certain surgical acts is the subject of a prior agreement of the medical control. They are only covered if they have received the favorable opinion of the medical examination, provided that the insured patient fulfills the legal conditions for awarding benefits.

When the procedure is submitted to this formality, the patient is required, prior to the execution of this procedure, to send to the medical control a request for prior agreement completed and signed by the doctor who must dispense the act. Requests for prior approval are made on forms that conform to the templates of the ministers responsible for health and social security.

The date of sending the request for prior agreement is evidenced by the postmark. The health insurance organization's (CPAM) response must be sent to the patient or the doctor, if applicable, no later than the fifteenth day following the date of receipt of the request by the medical examination.

🇬🇧About the translation: Parts of the English version of this website were translated using computer generated translation. If you notice a significant error or if you have any doubt regarding the medical information provided, please send us a message.

Dr Cédric Kron - Plastic surgeon in Paris

Former resident, Gold Medal of Surgery and Head of Clinic of Paris Hospitals (APHP), Dr. C. Kron is qualified in Plastic, Cosmetic and Reconstructive Surgery. He practices as a plastic surgeon in Paris, with a comprehensive and tailor-made approach of aesthetic treatments.