CommercialCoverageMedium impact
Reduction Mammoplasty
Blue Cross & Blue Shield of Mississippi·MS · Plastic Surgery, General Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive policy establishing coverage criteria for reduction mammoplasty procedures. For females, bilateral reduction mammoplasty requires specific symptomatology documentation, minimum tissue removal amounts based on height, and 6 months of chart documentation. For males, gynecomastia surgery has specific exclusions and requirements.
Action Required
Immediately: Billing and clinical teams must implement new documentation requirements for reduction mammoplasty claims. Create checklists ensuring all female patients have 6 months of chart documentation showing height/weight, anticipated tissue removal amounts, and symptomatology. Verify minimum tissue removal requirements per patient height are met via pathology reports. For male gynecomastia cases, document that exclusions (obesity >10% ideal body weight, drug-related causes, age <18) do not apply. Update encounter forms and EMR templates to capture required clinical indicators.