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Breast Reduction Surgery - UHCprovider.com

Breast Reduction Surgery Page 1 of 6 UnitedHealthcare Commercial Coverage Determination Guideline Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc. UnitedHealthcare Commercial Cover a ge Deter mina tion Guideline Breast Reduction Surgery Guideline Number: Effective Date: May 1, 2020 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 3 Definitions .. 3 Applicable Codes .. 4 Benefit Considerations .. 5 References .. 5 Guideline History/Revision Information .. 6 Instructions for Use.

Mastectomy and who elects breast reconstruction in connection with such Mastectomy, coverage for (1) r econstruction of the breast on which the Mastectomy has been performed; (2) surgery and reconstruction of the other breast to produce symmetrical appearance; and (3) prostheses and physical complications all stages of Mastectomy, including ...

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