All PlansCoverageMedium impact
Augmentation Mammoplasty
Blue Cross & Blue Shield of Mississippi·MS · Plastic Surgery, General Surgery, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive policy outlining coverage criteria for augmentation mammoplasty, specifying when breast augmentation is covered (reconstructive purposes only) versus excluded (cosmetic purposes). The policy includes specific conditions that qualify for reconstructive coverage and required documentation.
Action Required
Immediately: Billing team must ensure proper documentation of medical necessity for all augmentation mammoplasty claims. Verify that clinical signs and symptoms are documented in history, physical, and operative notes. Only bill for reconstructive cases meeting policy criteria (breast asymmetry >50%, congenital deformities, post-mastectomy reconstruction, etc.). Claims for cosmetic procedures will be denied.