Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | B-33 |
Topic: | Female Breast Reduction Surgery |
Effective Date: | August 1, 2005 |
Issued Date: | August 1, 2005 |
Date Last Reviewed: | 07/2005 |
Indications and Limitations of Coverage
Reduction mammoplasty (breast reduction) is a surgical procedure designed to remove a variable proportion of breast tissue. Reduction mammoplasty may be considered medically necessary for the treatment of macromastia causing well-documented clinical symptoms. Procedures performed primarily to improve the appearance of the breast are considered to be cosmetic in nature and therefore not covered. Reduction mammoplasty is considered medically necessary when all of the following criteria are met:
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19318 |
Exceptions: |
Highmark Medical Policy Bulletin S-28 |
In 1943, the Metropolitan Life Insurance Company introduced their standard height-weight tables for men and women. The tables were revised slightly in 1983.
Height & Weight Table For Women
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