Breast Reconstruction Following Mastectomy or Lumpectomy - (0178)

Cigna covers medically necessary breast reconstruction and external breast prostheses after mastectomy or lumpectomy (including areolar/nipple reconstruction/tattooing, autologous fat transfer, implant/expander and flap procedures, and contralateral symmetry operations; GalaFLEX/P4HB added 4/15/2025), but excludes many specifically listed ADMs/meshes/scaffolds/biologics and procedures (e.g., numerous named acellular dermal matrices, adipose‑derived stem cell–enriched fat grafting, xenograft cartilage grafting) as experimental/investigational/unproven and treats standalone donor‑site asymmetry correction as cosmetic/not medically necessary. Key requirements: submit appropriate covered diagnosis and procedure codes with supporting clinical documentation, bill services separately only when explicitly allowed, intraoperative perfusion assessment is integral (not separately reimbursable), and coverage is subject to applicable benefit plan terms and laws.

"Coverage for breast reconstruction and breast prostheses following mastectomy or lumpectomy is governed by federal and/or state mandates."