Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy 10.01.01
Summary
Excellus policy 10.01.01 considers reconstructive breast surgery during or after mastectomy, including partial mastectomy for benign or malignant disease, medically appropriate. Covered services may include breast implants, abdominal flap reconstruction, chest wall reconstruction, nipple and areola reconstruction and tattooing, surgery for symmetry of the opposite breast, basic breast prostheses, mastectomy bras, and treatment of physical complications of mastectomy including lymphedema. A risk-reducing mastectomy is considered medically appropriate for individuals with lobular carcinoma in situ, a known BRCA1 or BRCA2 variant, another high-risk gene variant, or chest radiotherapy between ages 10 and 30, and the 08/20/26 annual review states that policy intent is unchanged.
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