Reduction Mammaplasty

Reduction mammaplasty is covered when breast hypertrophy causes significant symptoms that interfere with ADLs for at least 6 months despite conservative management, or when specific complications such as inframammary skin breakdown, shoulder grooving, or spine-related symptoms are present and refractory to treatment. Cosmetic breast reshaping is not covered, but reduction for symmetry after medically necessary mastectomy and procedures meeting documented indications (including guidance on grams removed relative to BSA) are considered medically necessary.

"Significant breast-related symptoms that interfere with activities of daily living (ADLs) for at least 6 months despite conservative management are an indication for reduction mammaplasty."

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