Breast Reduction Surgery (Reduction Mammaplasty) Medical Policy
This policy governs UnitedHealthcare's coverage stance for breast reduction surgery (reduction mammaplasty) as reconstructive and medically necessary in certain circumstances and indicates states where this specific policy does not apply. It affects providers seeking prior authorization and claims adjudication for reduction mammaplasty for covered members.
Added language to indicate this Medical Policy does not apply to the state of Nebraska; refer to the state-specific policy version.
Added language to indicate this Medical Policy does not apply to the states of Idaho and Kansas; refer to the state-specific policy versions.
Clarified that benefit coverage is determined by federal, state, or contractual requirements and that medical records may be required for review.
Removed content/language pertaining to the state of Louisiana.
Removed content/language pertaining to the state of Mississippi.
Removed reference link to the Medical Policy titled Panniculectomy and Body Contouring Procedures.
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.