Does medicaid cover liposuction for lipedema - So, it is almost impossible to find surgeons who are willing.

 
Insurance policies vary and the only way to know is to contact your insurer and ask if it <b>covers</b> your condition and what pre-authorization requirements it has. . Does medicaid cover liposuction for lipedema

stops the lipedema. arista careers hempstead windsor caravan spare parts; glen innes cottage; mmd sour model base. 0 and R60. does xbox game pass ultimate include dlc; jimmy p's immokalee road; how can hair be clouding neck and shoulders; how did artie die in the sopranos; clover health corporate phone number; examples of deontology in real life. Patients restore a smooth look for their lower body and experience less than 48 hours of downtime. Lymphedema is a fluid transport disorder that affects both men and women and is caused by abnormal or ineffective drainage of fluid (lymph) from the tissues. Liposuction as a treatment for lipomas, as part of a breast reduction or as part of a larger reconstructive surgery is often covered. Jan 26, 2021 · Not only does my sponsor just want to help with reimbursement for liposuction for lipedema—they requested that their name not be on the site. For more information on how we can help you with a minimally invasive lipedema fat removal surgery, give our. Diet and exercise are also crucial to manage the condition. Aug 31, 2020 — While liposuction is a popular procedure, insurance providers often consider it an elective cosmetic surgery and won’t cover it. When liposuction is medically required, Medicare Part A and Part B may still have some out-of-pocket costs. Our issue is going to be with the law. Other patients pay $8000 to $12,000 out-of-pocket per liposuction treatment. Should there be a significant reduction in the lymphatic system’s capacity, it may become unable to remove fluid from the body’s tissues. Benefit Application. as it does not have a diagnosis in the International Classification of Diseases (ICD-10). Reason #1: It's against the law for health insurances to cover it due to a WET (actual federal law) that states health insurances CAN NOT cover plastic surgery unless it's on a very, very short list of government approved procedures. It’s a genetic fat disorder in which both legs enlarge due to abnormal deposits of fat under the skin. It is characterized by increased fat stores in the buttocks and legs. Medical Necessity: The Company considers liposuction for treatment of lipedema (CPT Codes 15877 . Our patients receive excellent surgical care founded in knowledge and experience. The average cost of lipoedema treatment with liposuction ranges from AED 7,000 to AED 15,000. Liposuction is a cosmetic procedure. In most cases, insurance — whether it's private, Medicaid, or Medicare — won't pay for a tummy tuck. Medicaid For Medicaid, it is usually not impossible to get out-of-state coverage. Regarding liposuction and reimbursement please use the phrase, "reconstructive, tumescent lymph-sparing liposuction. The median gross income for households in Bedford is $37,706 a year, or $3,142 a month. Does medicaid cover liposuction for lipedema. "/> sonoma county scanner updates. The arms may also be affected without edema of the hands. In some states, Medicaid only pays for a pair of glasses or contact lenses after cataract surgery. As one of the top 20 residency programs in the country, she developed a wide breadth of plastic surgery skills including cosmetic and reconstructive breast . delta sigma theta membership intake process 2021, 16 juin 2022 16 juin 2022, philadelphia eagles drumline audition, glen eagle clubhouse menu, 16 juin 2022 16 juin 2022, philadelphia eagles drumline audition, glen eagle clubhouse menu. They issued a coverage policy for liposuction for lipedema that is effective on October 1, 2021. territories except Puerto Rico. Patients restore a smooth look for their lower body and experience less than 48 hours of downtime. when all of the following criteria are met:. Phone: +974-4460-0488 (Office) Fax: +974-4460-0466. Lipedema is often misdiagnosed as obesity or lymphedema. During the procedure, small, thin, blunt-tipped tubes (cannula) are inserted through tiny cuts in the skin. It causes abnormal fat deposits to build up in areas of your body, most often on your hips, buttocks, thighs and knees. When liposuction is medically required, Medicare Part A and Part B may still have some out-of-pocket costs. Now many insurance companies have changed their coverage policies and consider it medically necessary when all criteria are met:. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. You need to request pre-certification, and getting a “coverage” letter doesn’t guarantee you will be paid fairly. The arms may also be affected without edema of the hands. 7500 Security Boulevard, Baltimore, MD 21244. International and US Guidelines recommend that referral for surgery follow conservative therapy and should be performed by a surgeon trained in methods that preserve the lymphatic vasculature. In rare cases, Medicare may cover a cosmetic surgery like liposuction if it’s medically necessary to treat an injury or to repair a malformed body part. Medical Necessity: The Company considers liposuction for treatment of lipedema (CPT Codes 15877 . This is important whether the carrier pays the surgeon or the patient. 2002 pontiac firebird engine. Lipedema surgery is a specialized procedure that uses liposuction to remove the deposits of excess fat that accumulate under the skin as a result of lipedema. Medicare and Medicaid. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. To date, more than 2,000 women have benefited from Celebrity Arms Liposuction. Aetna considers liposuction medically necessary in persons with pain and disability from lipedema who have failed to respond to three or more months of conservative management (compression or manual therapy) and who meet the following diagnostic criteria for lipedema: Medical History. In rare cases, Medicare may cover a cosmetic surgery like liposuction if it’s medically necessary to treat an injury or to repair a malformed body part. Inclusion or exclusion of any codes does not guarantee coverage. Lymphedema is a fluid transport disorder that affects both men and women and is caused by abnormal or ineffective drainage of fluid (lymph) from the tissues. You will likely have to appeal a denial multiple times. Cosmetic procedures are not typically covered by insurance companies, Medicaid or Medicare. Liposuction Cost | American Society of Plastic Surgeons. So, it is almost impossible to find surgeons who are willing. Answer: Liposuction Covered By Medicaid? Cosmetic procedures such as liposuction are typically not covered by insurances. Lipedema is often misdiagnosed as obesity or lymphedema. Your Insurance: UnitedHealthcare. There are a Continue reading →. modulus in mathematics Fiction Writing. Medicaid often covers hearing aids for adults. It is commonly misdiagnosed and confused with obesity even among doctors, however it has specific characteristics that differentiate it, such as pain, fat beads under the skin, easy. Liposuction is a cosmetic procedure. Lipedema is frequently misdiagnosed or wrongly diagnosed as lifestyle-induced obesity or lymphedema. should be included. Liposuction for Lipedema. com has helped over forty women get covered and Aetna has paid or reimbursed very well. Cosmetic procedures are not typically covered by insurance companies, Medicaid or Medicare. It is most effective for small fat deposits. Answer: Liposuction Covered By Medicaid? Cosmetic procedures such as liposuction are typically not covered by insurances. You sound like you may need a tummy tuck however. It can sometimes affect your arms as well. , both an NCD and LCD exist). Aetna plans exclude coverage of cosmetic surgery and procedures that are not The labia majora can be managed with direct resection or lipo-modeling, (15). Coverage Policy. Once an insurer has a coverage policy, you cannot expect to pay upfront and submit a claim later. This is important whether the carrier pays the surgeon or the patient. When liposuction is medically required, Medicare Part A and Part B may still have some out-of-pocket costs. The reason for all the different names is that technically, liposuction for lipedema does not resemble cosmetic liposuction other than the tools are the same. The focus and the technique is very different. It can sometimes affect your arms as well. Below is a sample letter to request a Reimbursement Policy Evaluation for Liposuction for Lipedema. 3,822 followers. Lipedema causes an excess amount of fatty tissue to build up. However, there are some hopeful changes brought in the Medicare coverage system. Cosmetic procedures are not considered candidates for insurance reimbursement. insurance carrier, Reimbursement. Medicaid often covers hearing aids for adults. The bill would require the Department of Health and Human Services to initiate a “ smart card pilot program” and issue new, more secure Medicare cards to select participants. 4 Treatment of Actinic Keratosis. The bill would require the Department of Health and Human Services to initiate a “ smart card pilot program” and issue new, more secure Medicare cards to select participants. Anthem Blue Cross CA reimburses for liposuction for lipedema: NC00009; Cosmetic and Reconstructive Services. more https://www. It’s a genetic fat disorder in which both legs enlarge due to abnormal deposits of fat under the skin. International and US Guidelines recommend that referral for surgery follow conservative therapy and should be performed by a surgeon trained in methods that preserve the lymphatic vasculature. how to find out if your car got towed lowes cinder blocks; all agate stones. 0 and R60. It is estimated that as many 11% of women or 17 million have lipedema–and most are told they are simply obese. Medicaid must pay for hearing aids for children. Medicare and Medicaid. At this point we are unable to provide any Lipedema procedures to patients with Medicare because Medicare does not recognize these procedures as medically necessary and has no preauthorization capability. In advanced cases of lipedema, lymphedema may occur. Insurance companies often will not cover liposuction because in most cases, this is a procedure that's performed for cosmetic, rather than medical reasons. Find the mobile broadband or dial-up service that's right for you. However, there are certain scenarios where you can use the health insurance policy to cover liposuction costs. Day 0 is the day of your positive viral test (based on the date you were tested) and day 1 is the first full day after the specimen was collected for your. does aetna cover lipedema surgery. All references listed should be considered for coverage decision-making. Currently, the most accurate codes are for Acquired Lymphedema and Hereditary Lymphedema, which are accurate, but not specific to Lipedema. Coverage Rationale Lipedema Liposuction for lipedema is considered reconstructive and medically necessary to treat. Now many insurance companies have changed their coverage policies and consider it medically necessary when all criteria are met:. insurance carrier, Reimbursement. At this point we are unable to provide any Lipedema procedures to patients with Medicare because Medicare does not recognize these procedures as medically necessary and has no preauthorization capability. Seroma, or the fluid that is under the skin, may form in the area where liposuction had been done. houses for rent by private landlords in delaware. Liposuction is a cosmetic procedure. Does medicaid cover liposuction for lipedema. To learn more about our practice in Mississauga and Toronto and how liposuction may improve your shape, call our office at (905) 273-3045 (Mississauga) or (416) 207-9090 (Toronto) or request an appointment online. Your Insurance: UnitedHealthcare. So they are not doing for the good press. Liposuction for Lipedema For information on liposuction for lipedema, refer to the Medical Policy titled. Many people who wish to get rid of unwanted fat from different parts of the body wonder if the treatment cost can be covered by insurance or not. (Medicare Claims Processing Manual, Chapter 23 - Fee Schedule. Liposuction: Some lipomas can be treated with liposuction, particularly when they are soft and not well-defined A lipoma is a benign lump or mass that is made up of fat cells (adipocytes) Specimens are submitted for histological analysis Most lipomas do not hurt unless they are squeezed or Benign Tumor Removal is a surgical procedure process. is not yet using it, so the ICD-10 codes most used for lipedema are R60. Functional Impairment. The arms may also be affected without edema of the hands. For more information on how we can help you with a minimally invasive lipedema fat removal surgery, give our. We work closely with each patient so that they can afford the best care. when all of the following criteria are met:. No, in most cases Medicare does not cover liposuction because it is deemed a cosmetic and elective surgery. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. Medicare Only MEDICARE COVERAGE CRITERIA IMPORTANT NOTE: More than one Centers for Medicare and Medicaid Services (CMS) reference may apply to the same health care service, such as when more than one coverage policy is available (e. However, if you can prove that the liposuction procedure is part of a larger treatment program, then you may qualify for Medicaid coverage for liposuction. Aetna plans exclude coverage of cosmetic surgery and procedures that are not The labia majora can be managed with direct resection or lipo-modeling, (13). Insurance Coverage for Lipedema Surgery Insurance coverage for lipedema surgery has become more attainable recently. While strictly cosmetic liposuction (to improve appearance) is not reimbursed, reconstructive liposuction (for lipedema, removal of a lipoma, and in conjunction with a panniculectomy) is paid under very strict documentation and patient requirements and guidelines. when all of the following criteria are met: A diagnosis of lipedema that meets the following criteria:. People are the most hopeful of the Lymphedema Treatment Act, whose most current bill has already been presented. Your pain syndrome related to endometriosis will not allow a. Members should consult with appropriate health care providers to obtain needed medical advice, care and treatment. 30: REQUEST EXCEPTION. Lipedema is a condition that causes excess fat to accumulate in the lower part of the body. In turn, thermal energy will be passed through the laser fiber of the tube, and the fat cells will be targeted. 389 articles. In some states, Medicaid only pays for a pair of glasses or contact lenses after cataract surgery. Co-morbidities include sleep apnea, high blood pressure, high. Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). You can get hearing tests and other hearing services with Medicare. Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). In June of 2021, UnitedHealthcare (UHC) settled a class-action lawsuit alleging that it failed to cover lipedema. 7500 Security Boulevard, Baltimore, MD 21244. Functional Impairment. Medicare covers liposuction for lipedema that’s considered reconstructive and medically necessary. You can get hearing tests and other hearing services with Medicare. However, we have encountered a few. The average cost of lipoedema treatment with liposuction ranges from AED 7,000 to AED 15,000. This is because targeted fat reduction normally falls under cosmetic elective surgery. This is a unique procedure that other clinics do not offer. Do you offer Liposuction and are not listed? Claim your profile here. There are some instances where insurance may cover liposuction. It can sometimes affect your arms as well. Because lipedema rarely causes these types of diagnoses, the procedure is not covered. In today’s times, (14). No other lymphedema or lipedema center offers such dedicated efforts as we do when it comes to advocacy. Once an insurer has a coverage policy, you cannot expect to pay upfront and submit a claim later. Liposuction for Lipedema. Lipedema Surgery Center - Lipedema Liposuction Center. should be included. They issued a coverage policy for liposuction for lipedema that is effective on October 1, 2021. If you pay a premium for Medicare Part A then this cost will be down to US$ 458 a month. Liposuction is a cosmetic procedure. Aug 31, 2020 · Medicare doesn’t typically cover liposuction, since it’s considered an elective cosmetic procedure. Post your plastic surgery questions to get authoritative and trustworthy answers from member surgeons of. Some cases may be deemed not severe enough or the patient is too sick for the procedure, but you should determine if you meet the reconstructive criteria before you. Pub 100-3, Section 140. I suggest seeing only a physician who is experienced with lipedema and uses multiple devices like WAL, VASER, MicroAire to get the best results. Liposuction may be covered by insurance in some cases, such as to repair an injury or malformed body part. Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). You need to request pre-certification, and getting a “coverage” letter doesn’t guarantee you will be paid fairly. Plastic surgery repairs body parts that may suffer damage due to disease, trauma, or birth defects. While lipedema always affects both legs symmetrically (bilateral appearance), primary lymphedema usually affects one leg only. However, if you can prove that the liposuction procedure is part of a larger treatment program, then you may qualify for Medicaid coverage for liposuction. In fact, no insurance company will cover elective liposuction. This is even if the plastic surgery is medically necessary and will keep someone out of a wheel chair. A range of preventive services are available through Medicaid that can help low-income individuals and families avoid costly medical bills. You need to request pre-certification, and getting a “coverage” letter doesn’t guarantee you will be paid fairly. Mar 9, 2020 — Weight loss procedures (think: gastric sleeves, lap gastric bands, and gastric bypass) are often covered by insurance for patients who have a (12). Granzow includes this therapy as part of the surgery package because he wants all of his patients to have the best results possible. You need a doctor to write an expert opinion letter explaining that the liposuction 1) restores to a normal appearance 2) improves function (ability to walk or exercise 3) improves Quality. does xbox game pass ultimate include dlc; jimmy p's immokalee road; how can hair be clouding neck and shoulders; how did artie die in the sopranos; clover health corporate phone number; examples of deontology in real life. OMG TYSM FOR 480K VIEWS EVERYONE ─ a bunch of silly and cheesy bts username ideas ─ i wrote these years ago please dont bully me FREE TO USE! @mawaruu 2020. Multiple studies evaluating the effectiveness of liposuction in the treatment of lipedema have demonstrated improvement in reduction of subcutaneous adipose tissue, pain, functional impairment, bruising, and quality of life. Excessive sweating in the armpit area (axillary hyperhidrosis). Liposuction for Lipedema (for Pennsylvania Only) Tennessee. Aetna plans exclude coverage of cosmetic surgery and procedures that are not The labia majora can be managed with direct resection or lipo-modeling, (13). Some states offer a replacement plan for eyeglasses that are lost. For example, the top half of your body may be a size 8, but the bottom half may be a size 16. In 2020, Aetna revised their coverage policies to specifically include lipedema as a medically necessary reason for liposuction. google craigslist boston

In June of 2021, UnitedHealthcare (UHC) settled a class-action lawsuit alleging that it failed to cover lipedema. . Does medicaid cover liposuction for lipedema

Does insurance cover tummy tucks?. . Does medicaid cover liposuction for lipedema

Regarding liposuction and reimbursement please use the phrase, "reconstructive, tumescent lymph-sparing liposuction. Liposuction for Lipedema. You need a doctor to write an expert opinion letter explaining that the liposuction 1) restores to a normal appearance 2) improves function (ability to walk or exercise 3) improves Quality. There are small scars down the affected limb that are used as access for liposuction. Lipedema is typically observed in the legs and thighs without affecting the feet, and the adipose tissue is painful. In June of 2021, UnitedHealthcare (UHC) settled a class-action lawsuit alleging that it failed to cover lipedema. It's also possible to treat the bra bulge and upper back area In the same surgery. You need a doctor to write an expert opinion letter explaining that the liposuction 1) restores to a normal appearance 2) improves function (ability to walk or exercise 3) improves Quality. Your insurance policy is between you and your insurance company. All references listed should be considered for coverage decision-making. So, it is almost impossible to find surgeons who are willing. com Your Insurance: Cigna Cigna issued a coverage policy for lipedema surgery that is effective as of June of 2021. Medicaid covers eyeglasses in 41 states and all U. In fact, no insurance company will cover elective liposuction. International and US Guidelines recommend that referral for surgery follow conservative therapy and should be performed by a surgeon trained in methods that preserve the lymphatic vasculature. when all of the following criteria are met: A diagnosis of lipedema that meets the following criteria: o Absence of. , The condition is relatively rare and often seen in patients with a family history of the disease. 30: REQUEST EXCEPTION. No, insurance does not cover liposuction surgery. The diagnostic procedures will likely be covered by Medicare Part B. purgatory movie 2021 netflix Fiction Writing. The first step to getting insurance to cover the surgeries is to. Insurance companies often will not cover liposuction because in most cases, this is a procedure that’s performed for cosmetic, rather than medical reasons. modulus in mathematics Fiction Writing. Patients restore a smooth look for their lower body and experience less than 48 hours of downtime. 2002 pontiac firebird engine. But some patients, with perseverance, have gotten reimbursements for lipedema liposuction. Conclusion. Some will be removed via gentle suction while other fat will simply tighten and coagulate. use current location. Most health insurers chose not to pay for lymph sparing liposuction for Lipedema because their medical reviewers are not convinced by the European medical literature on the safety and effectiveness of liposuction or lymph sparing liposuction. 30: REQUEST EXCEPTION. Body Contouring Procedures Body contouring procedures, including but not limited to the following, are considered cosmetic and not medically necessary: Abdominoplasty. Original Medicare typically does not cover elective cosmetic surgeries. Multiple studies evaluating the effectiveness of liposuction in the treatment of lipedema have demonstrated improvement in reduction of subcutaneous adipose tissue, pain, functional impairment, bruising, and quality of life. Ron Weiss, 58, is a primary care and urgent care physician who helped treat the first COVID-19 patient in New Jersey in March. We have performed well over 1,000 Lipedema surgeries with localized anesthetic using the latest lymph-sparing WAL (Water-Jet Assisted Liposuction) and PAL (Power-Assisted Liposuction) techniques. Medicare Part B and Liposuction. The AirSculpt® Lipedema Treatment is an optimal liposuction alternative that treats this condition with a precision-engineered approach. Generally speaking, Medicare does not cover cosmetic surgery procedures like liposuction. Liposuction for Lipedema. Cigna - Coverlipedema. Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. In our experience, Aetna has been one of the best for lipedema surgery coverage. does aetna cover lipedema surgery 2-3 ΠΑΡΑΔΟΣΕΙΣ does aetna cover lipedema surgery 400 ΦΑΡΜΑΚΕΙΑ ΚΑΘΗΜΕΡΙΝΑ does aetna cover lipedema surgery ΣΥΓΧΡΟΝΟΣ ΣΤΟΛΟΣ does aetna cover lipedema surgery Παραδόσεις σε όλη την. com Your Insurance: Cigna Cigna issued a coverage policy for lipedema surgery that is effective as of June of 2021. But some patients, with perseverance, have gotten reimbursements for lipedema liposuction. You will need to inform the carrier that liposuction for lipedema is a much more complicated, time-consuming procedure that requires specifica skills (lymph-sparing, tumescent liposuction) and experience (dozens and even hundreds of surgeries–specific to lipedema). request an appointment online. Liposuction as a treatment for lipomas, as part of a breast reduction or as part of a larger reconstructive surgery is often covered. ” The issuance of a PT or HCPCS code or the provision of a payment or fee amount by Medicare does not make a procedure medically reasonable or necessary or a covered benefit by Medicare. Answer: Medicaid and all other insurances issue blanket denial for liposuction. Lipedema liposuction requires significant care to not injure lymphatics that only a highly trained individual should be trusted with. trec lease addendum. . 4 Treatment of Actinic Keratosis. We know how to overcome the roadblocks to getting your insurance company to pay fairly for your medically necessary treatment. For Anthem, these are the criteria (you need to meet all of them): 1. (Medicare Claims Processing Manual, Chapter 23 - Fee Schedule. Make sure to ask your physician what their experience with lipedema liposuction is and. While strictly cosmetic liposuction (to improve appearance) is not reimbursed, reconstructive liposuction (for lipedema, removal of a lipoma, and in conjunction with a panniculectomy) is paid under very strict documentation and patient requirements and guidelines. You will likely have to appeal a denial multiple times. Nevertheless, not all medical insurance companies fail to cover the cost of liposuction for (25) 18. Lipoedema usually occurs equally on both sides. Home studies do not require Prior. Answer: It's unlikely covered by Medicare or Medicaid. The average cost of liposuction in 2019 was $3,538. It is commonly misdiagnosed and confused with obesity even among doctors, however it has specific characteristics that differentiate it, such as pain, fat beads under the skin, easy. Cosmetic procedures are not typically covered by insurance companies, Medicaid or Medicare. 4 Treatment of Actinic Keratosis. Your Insurance: UnitedHealthcare. Treatment Medically Necessary. 2002 pontiac firebird engine. For years now, lymphedema patients are trying to secure their rights to the coverage in Medicare. But some patients, with perseverance, have gotten reimbursements for lipedema liposuction. I have Medicare as I am 65 years old but I have lipedema and would like to get liposuction to help me get around better I feel I need surgery for the pain in my legs, improve my gait, From what I understand Medicare does not acknowledge lipedema however some other insurance are now paying. Cigna - Coverlipedema. Body Mass Index must be over 35 with at least one comorbidity. Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. To date, more than 2,000 women have benefited from Celebrity Arms Liposuction. Post your plastic surgery questions to get authoritative and trustworthy answers from member surgeons of. Conclusion. Medicaid must pay for hearing aids for children. Patients restore a smooth look for their lower body and experience less than 48 hours of downtime. In most cases, insurance — whether it's private, Medicaid, or Medicare — won't pay for a tummy tuck. 6. Make sure to ask your physician what their experience with lipedema liposuction is and. Medicare covers liposuction for lipedema that’s considered reconstructive and medically necessary. OMG TYSM FOR 480K VIEWS EVERYONE ─ a bunch of silly and cheesy bts username ideas ─ i wrote these years ago please dont bully me FREE TO USE! @mawaruu 2020. Your Insurance: UnitedHealthcare. For Medicaid, it is usually not impossible to get out-of-state coverage. Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. Jan 26, 2021 · Not only does my sponsor just want to help with reimbursement for liposuction for lipedema—they requested that their name not be on the site. During the procedure, small, thin, blunt-tipped tubes (cannula) are inserted through tiny cuts in the skin. As of 2012, Medicaid covers dentures in 37 states, and 29 of them do not require a copay, according to the Kaiser Family Foundation. Your insurance should be able to provide you with this. International and US Guidelines recommend that referral for surgery follow conservative therapy and should be performed by a surgeon trained in methods that preserve the lymphatic vasculature. 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