Does Medicare Cover Breast Reduction

Medical insurance providers don’t provide coverage for various medical procedures, cosmetic surgery is one of them.

A woman who wants to go for a breast reduction procedure has one question in common: does Medicare cover breast reduction?

Let’s find out the answer.

What is Breast Reduction

Cosmetic surgery is a specialized branch of plastic surgery focused on enhancing appearance through surgical and medical techniques. Cosmetic surgery is a part of plastic surgery performed by skilled plastic surgeons using advanced tools and equipment.

Unlike the standard plastic surgery procedures, cosmetic surgery procedures are there to makeover a person’s personality.

Breast reduction is one of the procedures of cosmetic surgery. The procedure is performed by a plastic surgeon to reduce the size of the woman’s breasts.

In medical terms, a breast reduction procedure is known as reduction mammoplasty.

The breast reduction procedure removes excess fat from the breasts. The same procedure removes unwanted glandular tissues across the breast areas including the unwanted skin.

The same procedure fixes the position of the nipples as per the woman’s demand.

Does Medicare Cover Breast Reduction

Medicare is the national health insurance scheme backed by the US Government.

Citizens who have availed of the facility of this health care scheme get medical procedures and other treatment at affordable rates.

Medicare is a national health insurance program in the U.S. designed to cover medical services, including some that may not be deemed ‘medically necessary’ under certain conditions.

Medicare may cover breast reduction surgery if it is deemed medically necessary, such as to relieve symptoms like back pain, skin irritation, or other health issues caused by large breasts.

In some cases, if the breast reduction procedure is medically needed, then it may be covered by Medicare under certain conditions.

Your medical provider will give you proper documentation to show the necessity of this procedure.

You have to show proper evidence of breast reduction and its necessity. Only then will you be provided with coverage under the Medicare scheme by the US Government.

There have been cases registered against surgeons who have provided wrong evidence and provided coverage for breast reduction and other cosmetic surgeries under the Medicare Scheme.

How do I know if I am eligible for Breast Reduction surgery

To get coverage under the Medicare Scheme for breast reduction, you need to provide medically approved documents.

If breast reduction surgery is medically necessary for a woman, only then will she get the coverage under the Medicare Scheme.

As per the previous surveys, if the woman is suffering from one of the following conditions, then she will be eligible for breast reduction under the Medicare scheme.

#1. Daily physical activities affected

Large breasts can put extra weight on the shoulders and other parts of the body which restrict the woman from doing their physical activities properly.

If you feel heavier with large breasts and want to reduce their size and weight, then you should be eligible for the breast reduction treatment.

#2. Chronic back pain

Back pain is the most common issue that every woman with large breasts faces. Large breast causes persistent back pain as they put up extra weight on the shoulders and back area.

#3. Skin irritation

Large breasts require heavy-duty undergarments. Undergarments are made from different materials, which include wires and elastic equipment. This causes skin irritation.

#4. Skin infections

Large breasts cause excessive sweat as they cover up a large area of the chest. Excessive sweat due to large breasts creates skin-related problems i.e. skin infections.

If the skin infection becomes persistent, then you can go for breast reduction under Medicare.

Are there any Medicare item numbers for breast reduction

There are three item numbers associated with breast reduction in the Medicare health care scheme. Here’s the list of all the three-item numbers that you can avail yourself of if breast reduction is medically necessary.

#1. 45520

45520 is also known as reduction mammaplasty. This method includes surgical repositioning of the nipples due to breast cancer or any other diseases developed in the woman’s breasts.

#2. 45522

45522 represents a reduction mammaplasty with no specific mention of being a non-surgical nipple repositioning procedure. All listed Medicare item numbers pertain to surgical interventions.

#3. 45523

45523 is bilateral mammaplasty for repositioning of the nipples. This method is performed on a woman who is suffering from persistent back pain and shoulder pain due to large breasts.

The Bottom Line:

Medicare Health Care Insurance is completely different from the health care insurance policies provided by private companies.

This health insurance policy provides coverage against all the major medical treatments at affordable rates.

Breast reduction can be considered a medically necessary procedure for some women with large breasts if specific symptoms or health issues are present.

However, the same procedure is covered by Medicare under certain conditions mentioned in the above article.

Study well about the Medicare insurance coverage, the conditions, and other related information before going for the breast reduction treatment.

See Also

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