Breast Reduction - (0152)

Covered: reduction mammoplasty (including contralateral reduction for symmetry after mastectomy and staged reduction/mastopexy before nipple‑sparing mastectomy) is medically necessary for women ≥18 or with completed breast growth with symptomatic macromastia, while purely cosmetic procedures (e.g., correction of benign inverted nipples, excision of redundant scar tissue) and liposuction as a sole treatment are not covered or are unproven. Key requirements: documentation of ≥1 qualifying symptom unresponsive to medical management, preoperative photos confirming significant hypertrophy (and shoulder grooving/intertrigo if present), and planned tissue resection >22nd Schnur percentile (or >1 kg per breast), plus age/breast‑growth evidence and appropriate CPT coding (19316/19318).

"Breast reduction surgery on the non-diseased/contralateral breast when performed to produce a symmetrical appearance following a mastectomy or lumpectomy is considered medically necessary."