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Valued Social Butterfly
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Re: Breast Reduction Surgery

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Medicare provides benefits for breast reduction surgery, also known as reduction mammoplasty, when it is medically necessary  to treat macromastia or breast hypertrophy that is causing adverse health effects. Women experiencing this condition typically suffer from back and neck pain, headaches and skin problems.

 

Two basic conditions apply for Medicare benefits: the condition must be present for at least six months and non-surgical medical intervention has failed to alleviate the symptoms.

 

The Dx has to fit the treatment and has to be covered in best practices - proven results.

 

Your Doctor could always ask for a ruling on the condition and coverage for this treatment - he has to present the facts and why this would be medically necessary.

 

If the breast reduction surgery is considered cosmetic in nature, Medicare will deny a claim for benefits.

 

A known fact is that it will not cure osteoporosis but the question to be answered would it help with the conditon.  This is where your doctor and surgeon have to make the case for it as being medically necessary.

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Breast Reduction Surgery

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This is an issue for many women, especially those who develop back problems and curvature due to osteoporosis.  Are any changes to this policy being considered?

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