Will Medicare Pay for Breast Reduction Surgery?

Will Medicare pay for breast reduction surgery? As I have gotten older, my breasts have become so heavy and large that I just have to do something. I am afraid of the anesthesia but it sounds like the surgery is a better option than lipo.

Doctor Answers 7

Medicare and Breast Reductions

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-I have performed breast reductions for patients with Medicare, and these patients' discomfort was greatly relieved.  Most patients' only regret was that they wished they hadn't waited so long to have the operation! 

-Because Medicare does not pre-authorize procedures, plastic surgeons need to be selective and only operate on breasts that they deem large enough to meet most insurances' size criteria.  These criteria are based on the height and weight of the patient in relation to the amount of breast tissue removed.

-Definitely meet with a board certified plastic surgeon to find out more details.

-Best of luck to you!


are large enough to meet the size criteria for the amount of breast tissue they

Medicare Breast Reduction

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Documentation by your physician is critical in having a chance for Medicare to pay for your surgery.  The amount of weight removed from your breasts and all your pre op symptoms are important.  Having your internist write a letter of support for the operation has helped in the past.  Either way it is still up to who ever gets the documentation to say yes or no if the bill is paid.

Medicare may or may not pay for breast reduction.

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With private insurance prior approval for the operation is obtained. With Medicare, the operation is performed and that agency decides whether or not it will pay for it in arrears. It's a very strange way to do business.

Medicare and coverage for breast reduction

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Medicare will only pay for a surgery that it deems medically necessary.  There is no pre-approval process with Medicare.  We call it Las Vegas, roll the dice and see if they pay. All that we can do as physicians is to document the problem as with any other patient and try to meet the same criteria as any other insurance company.  Unfortunately with Medicare it is only in retrospect that Medicare determines eligibility.  If they deny payment then they could not only deny payment to the physician but to the hospital as well.  Not a good workable situation for anyone involved. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Will Medicare Pay for Breast Reduction Surgery?

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Thank you for your question.

Medicare may pay for this surgery but the first step will be to find a surgeon whom you are comfortable with and who can submit the information needed for medicare to approve the surgery.

There are criteria that need to be met such as how much tissue needs to be removed, if you have history or neck, back or shoulder pain, etc.

Meet with well experienced plastic surgeons in  your area who work with Medicare and allow them to help you with this process.  Breast reduction surgery is one of the most patient pleasing operations I perform.


Medicare coverage for breast reduction

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Medicare will pay for the procedure if its criteria have been met.  This involves documented medical testing (orthopedic, neurologic), conservative management (medication, physical therapy, chiropractic) and the resection of a significant amount of gram weight.  Medicare does not pre-authorize cases so it is extremely important for your plastic surgeon to be upfront with you about the potential cost in the event that the case is denied.  I select my Medicare reductions very carefully so there are no surprises after the fact.

Medicare Covering Breast Reduction

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There are several factors that will determine coverage for you. It will depend on how much tissue is to be removed, most insurance companies require a minimum of 500 grams needing to be removed from each breast. What are your symptoms? Do you have grooving in your shoulders from your bra straps? Do you have back and neck pain? Have you tried analgesics to relieve your pain? Have you tried physical therapy? You will need documentation of anything you have tried from your physician. Unfortunately, Medicare's reimbursement is very low for surgeons, in fact may not even cover their costs, so you may have trouble finding a surgeon that will do it. If you are near a teaching college, sometimes they have programs that have very reduced fees for surgery which will be done by a resident under supervision. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.