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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 .. 6 Coverage Rationale See Benefit Considerations Indications for Coverage Most UnitedHealthcare plans have a specific exclusion for Breast Reduction Surgery except as required by the Women's Health and Cancer Rights Act of 1998.

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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