CurrentUnitedHealthcarePolicy CS011NE.V

Breast Reconstruction (for Nebraska Only)

State-specific UnitedHealthcare medical policy governing coverage and medical necessity criteria for breast reconstruction procedures, related adjunct procedures (nipple/areola creation, mastopexy, implant/tissue expander use, ADM), treatment of post-mastectomy complications (lymphedema, infection), implant removal for Allergan BIOCELL textured implants, and correction of inverted nipples or congenital anomalies — applicable only in Nebraska.

Policy Summary

PayerUnitedHealthcare

PolicyBreast Reconstruction (for Nebraska Only)

Policy CodePolicy CS011NE.V

Change TypeDocumentation language addedreferences updated

Effective DateNov 1, 2025

Next Review Date

Key ActionPatient medical record must contain documentation that fully supports medical necessity including relevant history, physical exam, and diagnostic test results; documentation must be legible and available upon request.

SourceLink

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.

POLICY UPDATE CHANGES

Medical Records Documentation Used for Reviews language added specifying documentation that may be required and that it does not guarantee coverage.

Supporting Information sections (Clinical Evidence, FDA, References) updated to reflect most current information.