Good News for Women with Lipedema: Insurance Coverage for Liposuction
Women suffering from lipedema have received encouraging news: liposuction, a procedure aimed at alleviating symptoms, will soon be covered by statutory health insurance under certain conditions, regardless of the stage of the disease.
The Federal Joint Committee (G-BA) has recently decided to include liposuction in the standard benefits catalog. Previously, the procedure was only reimbursed by health insurance for patients in advanced stage III.
What is Lipedema?
Lipedema is a chronic fat distribution disorder that predominantly affects women. It is characterized by symmetrical fat accumulation, severe pain, and tenderness, most commonly affecting the legs. The severity of symptoms varies among individuals; some may experience stable conditions, while others may see a progression over time.
Liposuction as an Insured Service: What Are the Requirements?
Liposuction can significantly alleviate pain and improve mobility by surgically removing the affected subcutaneous fat tissue. According to a recent study, the procedure offers clear advantages over non-surgical treatments such as compression therapy or exercise.
However, there are specific criteria for insurance coverage:
- The patient must not have gained weight in the six months prior to the surgery.
- If the patient’s BMI is between 32 and 35, the waist-to-height ratio (WHtR) must be lower than the threshold corresponding to their age:
– 40 years and younger: 0.5
– 41 to 49 years: increases by 0.01 for each additional year
– 50 years and older: 0.6 - For patients with a BMI over 35, weight loss is required before the health insurance will cover the costs of liposuction.
- The diagnosis must be confirmed by two specialists as part of a four-eyes principle.
- A conservative therapy must be consistently conducted for six months before liposuction can be approved.
Additionally, the diagnosing and operating physicians must be appropriately qualified, and meticulous surgical planning and aftercare are mandatory.
When Will the Regulation Take Effect?
The G-BA’s decisions will now undergo legal review by the Federal Ministry of Health. Once published in the Federal Gazette, they will come into effect. The necessary billing codes are expected to be established by January 1, 2026, at which point liposuction will officially be an outpatient service covered by health insurance for stages I and II.