Reduction Mammaplasty

This policy covers reduction mammaplasty for adults (≥18) when medically necessary — for symptomatic macromastia causing significant back/neck/shoulder pain, recurrent intertrigo, ulnar neuropathy, staged procedures related to post‑mastectomy reconstruction or trauma, and select pre‑mastectomy reductions to preserve nipple viability. Coverage requires failed conservative measures and documentation of ADL‑impacting symptoms, a Schnur Sliding Scale calculation showing glandular tissue to be removed >22nd percentile per breast with post‑operative pathology confirming glandular tissue and amount; cosmetic reductions, patients <18, gender‑reassignment services, and liposuction‑only reductions are excluded.

"Reduction mammaplasty associated with post-mastectomy reconstruction with contralateral breast surgery"

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