The question of reimbursement for nymphoplasty frequently arises among our patients. In this article, we explain the conditions for reimbursement, the steps to follow and all the formalities required to obtain reimbursement from the CPAM or your complementary health insurance, when the procedure is medically justified.
Nymphoplasty reimbursement: conditions for coverage of labioplasties
Nymphoplasty: an update on the surgical procedure
Nymphoplasty involves reducing the size of the female labia minora. The operation is intended to improve a woman's comfort or intimate appearance.
This gynecological operation, also known as reduction nymphoplasty, requires local or general anesthesia.
This surgery is generally performed under local anaesthetic and takes between 30 and 60 minutes. Scarring is generally discreet, as the scar blends into the natural folds of the lips, guaranteeing a harmonious, natural result.
After 2 to 4 days' convalescence, the patient can resume her daily activities.
It is advisable to wait 1 month before resuming sport or sexual relations.
Restorative or cosmetic nymphoplasty: the differences
Reduction nymphoplasty can be performed for functional or aesthetic reasons. This gynecological surgery is indicated in two cases:
- Reconstructive nymphoplasty: performed on women suffering from chronic daily discomfort or pain.
- Aesthetic nymphoplasty: some patients experience no physical or psychological discomfort, but wish to improve the aesthetic appearance of their private parts. In this case, the procedure is considered cosmetic surgery and is based on a personal choice.
Focus on medical nymphoplasty
Sometimes, the disproportion of the labia minora causes pain of varying intensity or female complexes.
This anomaly may be caused by :
- A congenital malformation
- A deformity following difficult childbirth or gynaecological surgery
Excess labial tissue can cause irritation, which is accentuated in certain situations:
- Wearing tight-fitting clothing
- Sporting activities
- Sexual relations
- Certain medical procedures performed on the intimate area
Criteria for reimbursement of nymphoplasty by the CPAM
Social Security reimburses reconstructive nymphoplasty only if the following two conditions are met:
- Hypertrophy of the labia minora is particularly marked
- It causes significant discomfort, psychological suffering or persistent pain.
In this case, the CPAM will cover part of the cost of the operation. Purely cosmetic nymphoplasty, on the other hand, is not reimbursed.
Nymphoplasty and Social Security reimbursement: what you need to know
A medical procedure listed in the CCAM
For a reduction nymphoplasty to be reimbursed, it must be medically indicated and carried out by a practitioner registered in sector 1 or 2. This procedure is recorded in the Classification Commune des Actes Médicaux (CCAM) under code JMMA005.
Please note: nymphoplasty/labioplasty does not require a prior agreement with your health insurance fund.
Amounts covered by health insurance
The basic Social Security rate for nymphoplasty is €57.44, of which 70% is reimbursed by the CPAM, i.e. €40.21.
Conditions for full reimbursement of nymphoplasty/labioplasty
In certain specific cases, the insured is exempt from the co-payment, which means that the procedure may be covered at 100% by the Assurance Maladie. This applies when :
- The operation is performed following post-delivery sequelae
- Nymphoplasty is necessary because of a long-term illness (ALD)
- The intervention follows an occupational trauma
- Treatment is covered under specific terms and conditions by the French health insurance system (Assurance Maladie).
Nymphoplasty Price: How much does nymphoplasty cost?
The price of a reduction nymphoplasty varies according to a number of criteria, including coverage and the surgeon's fees. For more details, please consult our price list.
Reimbursement and coverage of nymphoplasty by mutual insurance companies
As Social Security coverage is only partial, some mutual insurance companies cover the remaining costs when nymphoplasty is justified on medical grounds.
Patients are advised to check the terms and conditions of their supplementary health insurance beforehand. Depending on the contract, she may benefit from :
- A package dedicated to surgical procedures
- Coverage in the event of hospitalization
- Reimbursement for post-operative nymphoplasty care
Claim procedure for nymphoplasty (labioplasty)
Consultation for reduction nymphoplasty
Before any operation, it is essential to consult an experienced plastic surgeon. His or her role is to assess whether the shape or size of the labia minora warrants an operation.
During this initial consultation, the surgeon :
- Carries out an in-depth medical interview
- Performs a clinical examination to analyze anatomy and any associated discomfort
- Determines if nymphoplasty is :
- Eligible for Social Security reimbursement
- Classified as a cosmetic procedure, not reimbursed
If the procedure is eligible for reimbursement, the surgeon will provide the patient with a detailed estimate specifying code JMMA005, which is required for CPAM reimbursement.
How to obtain reimbursement for nymphoplasty from your health insurance company
The CPAM only covers part of the cost of nymphoplasty. To cover the remainder, the patient can forward her surgical estimate to her complementary health insurance company, which will check whether :
- Excess fees (surgeon and anaesthetist)
- Post-operative follow-up consultations and labioplasty convalescence.
- Hospitalization costs
The CPAM generally transmits the invoice directly to the mutual insurance company via a digital exchange. If this is not the case, the patient must send the invoice to her complementary health insurance :
- The CPAM reimbursement statement
- Detailed invoice from the healthcare facility, specifying the procedures performed and their cost
After examining the file, the mutual insurance company communicates the exact amount of care reimbursed.
Would you like to know more about your eligibility for this procedure? What are the after-effects or how much does it cost? Please contact us to make an appointment.
