Surgical Treatment for Chest Wall Deformities - (0309)

Cigna covers surgical repair of pectus excavatum only when imaging shows a Haller index >3.25 plus either abnormal pulmonary function or imaging evidence of external cardiac compression; covers pectus carinatum only when there is documented significant cardiac or respiratory functional impairment expected to be corrected by surgery; and covers Poland syndrome repairs (including initial one- or two-stage breast reconstruction) when preoperative photos or imaging document absent/hypoplastic pectoralis muscle or ribs, while procedures for other indications are not medically necessary and the Magnetic Mini Mover Procedure (3MP) is experimental/unproven. Key requirements: thorough documentation (CT/MRI/radiographs to confirm Haller index or chest/rib defects, PFTs, cardiac studies, preoperative photos for Poland syndrome), evidence of physiologic impairment or progression/failed prior repair when applicable, and recognition that plan benefits, cosmetic exclusions, and timing (typically near completion of pubertal growth) may limit coverage.