Breast Related Procedures
Defines medical necessity, exclusions, prior authorization, and coverage rules for breast-related procedures including implant removal, reduction mammoplasty, reconstruction/revision, gynecomastia surgery, mastectomy for intractable pain, imaging (mammography/DBT/MRI/BSGI), bioimpedance for lymphedema, and related services. Applies across product lines with product-specific PA rules and references InterQual/Evicore criteria where indicated.
En bloc capsulectomy medically necessary only for established or suspected breast implant-associated cancer; all other indications not medically necessary.
Photographic documentation must be submitted with all prior authorization requests.
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.