Gynecomastia Surgery – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers mastectomy for gynecomastia as reconstructive and medically necessary only for stage II–IV glandular gynecomastia causing documented moderate–to‑severe chest pain with a functional/physical impairment (inability to play sports/socialize alone is insufficient), persistent after cessation of causative medications/substances, with appropriate normal laboratory evaluation (for males <18 gynecomastia must persist ≥2 years) and documentation that glandular—not fatty—tissue is the primary cause. Most plans exclude treatment of benign or fatty (pseudogynecomastia), coverage is subject to member‑specific benefits, and required documentation includes physical exam, imaging, labs, medication/substance history and prior medical therapy.

"A mastectomy to treat Gynecomastia in a male under the age of 18 is considered reconstructive and medically necessary when all of the following criteria are met:"