Guidelines For Medical Necessity Determination For Breast Reduction

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Guidelines for Medical Necessity …

https://www.mass.gov/files/documents/2019/07/24/mng-reduction-mammoplasty.pdf

LCD - Reduction Mammaplasty (L35001) - Centers for …

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35001&DocID=L35001

There are wide variations in the range of height, weight, and associated breast size that cause symptoms. The amount of tissue that must be removed in order to relieve …

Article - Billing and Coding: Reduction Mammaplasty …

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56837&LCDId=35001&DocID=L35001

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a …

Breast Reduction Surgery and Gynecomastia Surgery

https://www.aetna.com/cpb/medical/data/1_99/0017.html

The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. The surgeon removes excess …

Breast Reduction Surgery - UHCprovider.com

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan/breast-reduction-surgery-cs.pdf

Coverage Rationale Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, …

MassHealth Guidelines for Medical Necessity …

https://www.mass.gov/guides/masshealth-guidelines-for-medical-necessity-determination-for-reduction-mammoplasty

Guidelines for Medical Necessity Determination for Reduction Mammoplasty. These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical …

MEDICAL POLICY - BREAST REDUCTION FOR …

https://www.bcbsm.com/amslibs/content/dam/public/mpr/mprsearch/pdf/76979.pdf

The safety and effectiveness of breast reduction have been established. It may be considered a useful therapeutic option (and not considered cosmetic) when: • Patient …

Breast Reduction Surgery – Commercial Medical …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/breast-reduction-surgery.pdf

All plans cover breast reduction surgeries that qualify under the Women’s Health and Cancer Rights Act of 1998. If a surgery does not qualify under the Women’s Health and …

Breast Reduction - Cigna

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0152_coveragepositioncriteria_reduction_mammoplasty_for_macromastia.pdf

Breast reduction is considered medically necessary for the treatment of macromastia (i.e., large breasts) in women at least 18 years of age, or with completed breast growth, when …

7.01.21 Reduction Mammaplasty - Blue Shield of …

https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_ReducMamma_BrstSymptoms.pdf

mammaplasty are not well-addressed in the published medical literature. Some protocols on the medical necessity of reduction mammaplasty are based on the weight of removed …

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Guidelines For Medical Necessity Determination For Breast Reduction