Medically Necessary Breast-Reduction



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Medically Necessary Breast-Reduction

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Breast Reduction – Mass.gov

www.mass.gov

These Guidelines for Medical Necessity Determination (Guidelines) identify the
clinical information. MassHealth needs to determine medical necessity for breast
reduction. These Guidelines are based on generally accepted standards of
practice, review of the medical literature, and federal and/or state policies and
laws.

Update 2015-30 – New Prior Authorization … – ForwardHealth Portal

www.forwardhealth.wi.gov

Jul 1, 2015 Reduction mammoplasty (breast reduction surgery) for female members with
breast hypertrophy (enlarged breasts) … medically necessary indications for
reduction mammoplasty. In order to be considered medically necessary, the
condition must be severe and unresponsive to dermatological treatments …

HealthChoice Health handbook for PY2017 – OK.gov

www.ok.gov

This health handbook replaces and supersedes any health handbook the Office
of Management and. Enterprise Services (OMES) Employees Group Insurance
Division (EGID) previously issued. This health handbook will, in turn, be
superseded by any subsequent health handbook OMES issues. The most current
version of …

NC Division of Medical Assistance Medicaid and Health Choice …

files.nc.gov

Oct 1, 2004 1.5. Breast Reconstructive Surgery. Breast reconstructive surgery is performed
following a mastectomy to establish symmetry with the contralateral breast or
following bilateral mastectomy. It includes the surgical creation of a new breast
mound and the nipple/areolar reconstruction, which is accomplished …

Criteria for Coverage of Bilateral Breast Reduction Mammoplasty for …

www.hss.gov.yk.ca

Apr 1, 2014 This policy applies to those eligible clients insured as defined by the Yukon
Health Care. Insurance Plan Act, who are seeking bilateral breast reduction
mammoplasty. Surgery that is not deemed to be medically necessary is
considered to be cosmetic surgery which is non-insured benefit as per the Yukon
 …

Important Information for Women About Breast Augmentation – FDA

www.accessdata.fda.gov

As part of your decision, both you and your surgeon will be required to sign
Allergan's consent to surgery form that … augmentation however, your surgeon
may find it medically necessary to perform surgery sooner. ….. Calcium deposits
also occur in women who undergo breast reduction procedures, in patients who
have.

HMO Coverage Info Report – New York State Attorney General

ag.ny.gov

for diabetes, surgery for Crohn's disease, arthroscopic knee surgery, enteral
formulas. (nutritional supplements) and breast reduction surgery. The particular
services or supplies were chosen because plans typically subject them to
medical necessity determinations. Every individual response was reviewed to
determine if it …

STATE OF VERMONT HUMAN SERVICES BOARD In re ) Fair …

humanservices.vermont.gov

authorization under Medicaid for coverage of breast reduction mammoplasty. The
issue … necessary, noting that there was no medical documentation of … medical
necessity. The petitioner indicated at the status conference that she had spoken
with her doctor and that neither he nor she would be submitting any additional.

Women's Health Services – Colorado.gov

www.colorado.gov

Feb 3, 2015 Breast reduction procedures for macromastia are covered when medically
necessary and when all medical criteria are met, including the documented
failure of alternative treatment for macromastia. • All breast reduction procedures
must be prior authorized and meet medical criteria. HYSTERECTOMY:.

2016 HSAC Meeting Minutes – Minnesota.gov

mn.gov

Nov 30, 2016 A. Medical necessity criteria (e.g., patient readiness considerations and
appropriate referrals) for coverage of gender …. A. Covered procedures: DHS will
cover the following procedures as medically necessary for individuals meeting …
Breast surgery (mastectomy; breast reduction; chest reconstruction) d.

Important Information for Women About Breast Augmentation – FDA

www.accessdata.fda.gov

As part of your decision, both you and your surgeon will be required to sign
Allergan's consent to surgery form that … augmentation however, your surgeon
may find it medically necessary to perform surgery sooner. ….. Calcium deposits
also occur in women who undergo breast reduction procedures, in patients who
have.

2013 United Healthcare Certificate of Coverage Choice Plan – dchr

dchr.dc.gov

scientific evidence and prevailing medical standards and analysis of cost-
effectiveness. After you contact … When we are notified as required, we will work
with you to implement the Care CoordinationSM process …… Breast reduction
except as coverage is required by the Women's Health and Cancer Right's Act of.
1998 for …

State Laws Relating to Breast Cancer – Centers for Disease Control …

www.cdc.gov

required that the state Board of Health's program for indigent cancer sufferers
include exami nations for breast … mammography coverage specifically applies
to Medicaid or comparable medical assistance programs in …… coverage for all
stages of one reconstructive breast reduction on the non-diseased breast to
make it …

5100168, Zang v. McKee, MD – Illinois Courts

www.illinoiscourts.gov

May 5, 2011 The plaintiff, Carrie Zang, filed a medical negligence action against the
defendants,. R. Craig … defendants improperly removed excessive breast tissue
during the breast reduction surgery and failed to ….. 'The elements necessary to
establish a negligence case for medical malpractice are the same as in …

Maine: State Required Benefits – CMS.gov

www.cms.gov

Medical Service Organizations. Title 24 §2324. Outpatient Surgery. Physician/
Surgical Services. Coverage for breast reduction surgery and symptomatic
varicose vein surgery. All contracts; the mandate applies to certificates issued in
Maine through group policies that are issued outside of Maine. Title 24 §2332-N;
Title …

Oregon Insurance Division Bulletin INS 2012-01 – Application of …

dfr.oregon.gov

For example, if an insurer provided coverage for breast reduction surgery to
alleviate back pain, the insurer could not deny breast reduction surgery for
gender reassignment purposes so long as the treatment is deemed medically
necessary. 3. This places an insured who is seeking coverage of a condition
related to GI/GD …

Oregon Division of Financial Regulation Bulletin DFR 2016-01 …

dfr.oregon.gov

insurance to the extent necessary to ensure equality of access to coverage,
treatment and other insurance services. … and to medically necessary health
care benefits, including benefits for the treatment of gender dysphoria. …. For
example, if an insurer provided coverage for breast reduction surgery to alleviate
back pain,.

City Health Plan (PPO) Handbook – City of Eugene

www.eugene-or.gov

Jun 1, 2016 Life and Long Term Disability Insurance. Effective June 1, 2016. This edition of
the Employee Benefits Handbook for employees on the City Health Plan
supersedes all previous benefit handbooks distributed to employees with City
Health Plan Preferred Provider Organization (PPO) medical coverage.