Breast Reconstruction – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers medically necessary breast reconstruction and related prostheses after mastectomy (including contralateral symmetry procedures, nipple/areola creation, ADM use, treatment of post‑mastectomy complications such as lymphedema, and removal of Allergan BIOCELL textured implants), and reconstruction for certain congenital anomalies or severe disfigurement, while excluding cosmetic procedures (e.g., augmentation, asymmetry corrections not meeting criteria, routine benign breast procedures, and other listed cosmetic exclusions). Coverage requires documentation and meeting InterQual clinical criteria (operative/pathology reports, implant records, lymphedema therapy orders, etc.), prior authorization/clinical review as applicable, and is subject to member‑specific benefit plan terms.

"Treatment for post-mastectomy complications including postoperative infection(s)."