Breast Excision and Mastectomy - Medicare Advantage

This policy covers breast excision and mastectomy procedures—including lumpectomy/partial mastectomy and related reconstructive considerations—for diagnostic and therapeutic management of breast lesions. It applies to patients with biopsy‑proven malignancy, suspicious imaging findings or palpable masses, early‑stage (I–II) breast cancer, and gynecomastia, but coverage is subject to applicable MAC LCDs (and NCD 140.2 for reconstruction), member contract terms, cosmetic exclusions, and local medical‑necessity determinations.

"Breast Reconstruction Following Mastectomy | 140."

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