Breast Surgery - MEDICAID - LOUISIANA

Covers breast surgery services including risk‑reducing mastectomy for patients with high‑risk genetic mutations (e.g., BRCA1/2), implant removal for complications (rupture, infection, BIA‑ALCL, extrusion, significant capsular contracture), reduction mammoplasty for symptomatic macromastia, congenital deformity correction, and reconstruction after therapeutic intervention or trauma. Coverage is governed by the Louisiana Medicaid MCO Manual and Professional Services Chapter Five and is limited — cosmetic procedures are not covered, risk‑reducing mastectomy requires NCCN recommendation, reduction mammoplasty requires objective criteria (e.g., ≥2 symptoms for ≥12 weeks and completion of pubertal development), implants must be FDA‑approved, and other prior authorization/criteria in the referenced manuals apply.

"Reconstructive breast surgery after a therapeutic intervention (e."