Medical Necessity Guidelines — Breast Surgeries
Guidelines governing when Mass General Brigham Health Plan considers breast surgeries medically necessary and requiring prior authorization; applies to treating specialists and surgeons requesting coverage for members across plan types.
Updated breast implant removal section to reference customized subset, which has been reinstated.
Updated prior authorization table and added variation for OneCare and SCO members.
Customized InterQual® criteria were added and later modified for breast implant removal and reconstruction.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.