All PlansCoverageMedium impact
Breast Reconstruction Following Mastectomy
Blue Cross & Blue Shield of Mississippi·MS · Plastic Surgery, General Surgery, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes comprehensive coverage requirements for breast reconstruction following mastectomy under the Women's Health and Cancer Rights Act of 1998. The policy covers reconstruction of the mastectomy breast, symmetrical surgery on the unaffected breast, prostheses, and treatment of complications including lymphedema.
Action Required
Immediately: Billing team must ensure all breast reconstruction claims include proper documentation that the mastectomy was performed due to disease process, congenital absence, or to restore bodily function. Update encounter forms to capture medical necessity documentation. Verify that symmetrical surgery on the contralateral breast is billed appropriately when performed for reconstructive purposes.