Reduction Mammoplasty Medical Policy

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FEP Medical Policy Manual - FEP Blue

https://www.fepblue.org/-/media/PDFs/Medical%20Policies/07-10-2020/70121%20Reduction%20Mammoplasty.pdf

Medical policies regarding reduction mammaplasty have focused on the distinction between a cosmetic procedure, performedprimarily to improve the appearance of the breast, and a medically necessary procedure, performed primarily to relieve documentedclinical …

CG-SURG-71 Reduction Mammaplasty - Anthem

https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_d073867.html

In 2022, the ASPS published an updated clinical practice guideline on reduction mammoplasty that included the following recommendation: “The work group recommends …

Breast Reduction Surgery and Gynecomastia Surgery

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

Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. For pain interventions, …

Breast reduction surgery - Mayo Clinic

https://www.mayoclinic.org/tests-procedures/breast-reduction-surgery/about/pac-20385246

Care at Mayo Clinic Print Overview Breast reduction surgery, also known as reduction mammaplasty, is a procedure used to remove excess fat, tissue and skin from the …

Breast Reduction Surgery – Commercial Medical …

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

Reduction mammoplasty documentation should include: o The evaluation and management note for the date of service o The note for the day the decision to …

LCD - Reduction Mammaplasty (L35001) - Centers for …

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

Reduction mammaplasty is the surgical removal of a substantial portion of the breast, including the skin and underlying glandular tissue, until a clinically …

Breast Reduction - Cigna

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

Reduction mammoplasty is the surgical excision of a substantial portion of the breast, including the skin and the underlying glandular tissue, until a clinically normal size is …

Breast Reduction Surgery - UHCprovider.com

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

Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® …

Cosmetic Surgery vs. Reconstructive Surgery | BCBSND

https://www.bcbsnd.com/providers/policies-precertification/medical-policy/c/cosmetic-surgery-reconstructive-surgery

Reduction mammaplasty may be considered medically necessary when clinical documentation shows AT LEAST two (2) of the following symptoms: Muscle …

Article - Billing and Coding: Reduction Mammaplasty …

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

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Reduction Mammaplasty. Coding Information: …

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