Breast Reconstruction (for Indiana Only)
This policy governs coverage and medical necessity criteria for breast reconstruction procedures and related services for UnitedHealthcare members in Indiana, including reconstruction after mastectomy, for congenital disorders, and treatment of post-mastectomy complications.
Added language clarifying medical records documentation requirements to support medical necessity and that such documentation may be required for review.
Removed CPT code 19380 from the applicable codes list.
Updated Clinical Evidence, FDA, and References sections to reflect current information.
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.