Breast Reduction Surgery – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare generally excludes breast reduction surgery except when required by the Women's Health and Cancer Rights Act of 1998 or when deemed reconstructive/medically necessary per InterQual; coverage for physiologic functional impairment or gender dysphoria is plan‑dependent and reduction for gynecomastia is excluded. Coverage requires medical-record documentation showing the applicable criteria are met (InterQual, WHCRA, or an included gender dysphoria benefit), confirmation of member‑specific plan benefits (the benefit document controls), and compliance with any Medicare/state/federal mandates.

"Breast reduction surgery that qualifies under the Women's Health and Cancer Rights Act of 1998."

Sign up to see full coverage criteria, indications, and limitations.