What is the criteria for Medicaid to cover a breast reduction and/or breast lift?

Question

I am a 38H. I have been getting repeated rashes under my breasts despite good hygiene practices, placing panty lines in my bra to absorb moisture, etc. The last rash spread onto my stomach and was extremely uncomfortable. It often hurts to wear bras now, even those without an underwire, because the area under my bust is very sorry.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
I would call your insurance company to find out the criteria/ requirements for this surgery to be covered. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best of luck!

Kenneth Hughes, MD · Answer

BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered, but there are other criteria such as amount of breast tissue removed. Check your Medicaid insurance plan to see if your case would be covered AND if it is, which plastic surgeons in your area would work with your plan. Reimbursement is so poor and such a bureaucratic hassle to collect that many PSs lose money on performing the surgery. Determine the availability of plastic surgery residents at the plastic surgery residency programs in GA who may perform your BR at a lower price if you have to pay for the surgery yourself.

Ronald J. Edelson, MD · Answer

The first thing you will need is to find a surgeon who will perform your procedure under Medicaid. That will most likely be a university teaching program. I would contact them and they can probably guide you through the steps involved.

Daniel Barrett, MD · Answer

Dear Considerate538986,
if your breasts are causing you issues, then there is a chance that insurance will cover the costs of reduction. Breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert L. Kraft, MD, FACS · Answer

Every Medicaid intermediary will have its own criteria which should be available online. Generally, a course of conservative management is required and most companies impose BMI maximums. For gigantomastia, they may not be as strict. Best wishes.

What is the criteria for Medicaid to cover a breast reduction and/or breast lift?

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What is the criteria for Medicaid to cover a breast reduction and/or breast lift?

Answers (5)

Answer: Breast reduction

Answer: Breast reduction

Answer: Medicaid reduction criteria

Answer: Medicaid reduction criteria

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.