Surgical Treatment of Gynecomastia

This policy covers surgical treatment of gynecomastia (surgical excision/mastectomy or liposuction) for benign male breast enlargement across age groups — including neonatal, adolescent, aging, obesity‑related, hormonal, and drug‑induced causes — particularly for symptomatic, persistent, bilateral disease or when fibrosis prevents spontaneous regression. Coverage is limited to procedures determined to be reconstructive per the member’s benefit contract (cosmetic procedures are excluded), requires prior conservative management/management of underlying causes, and is subject to plan and state‑specific limitations with limited high‑quality evidence supporting outcomes.

"Surgical treatment of gynecomastia may be eligible for coverage when, per the member's benefit contract, the procedure is considered reconstructive rather than cosmetic."

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