Breast Reconstruction - MEDICAID - FLORIDA

This policy covers breast reconstruction services including autologous flap procedures (e.g., TRAM, DIEP, GAP, LD, PAP, SIEA, TAP/TDAP, TUG), implant- and expander-based reconstruction, nipple/areola reconstruction and tattooing, revision surgeries, chest‑wall flat closure, oncoplastic and immediate reconstruction after mastectomy or trauma, and intraoperative fluorescent perfusion imaging to assess tissue viability. It applies to patients after mastectomy, tumor resection or breast trauma and for implant complications (e.g., capsular contracture), but chest‑wall flat closure is limited to those not candidates for or electing against reconstruction, intraoperative imaging examples are limited to FDA‑approved systems, and actual coverage, limits and medical‑necessity determinations may vary by member plan and medical director review.

"19316 Mastopexy"

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