MedicaidCoverageMedium impact
Breast Surgery - MEDICAID - LOUISIANA (Revised)
Humana·LA · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
May 18, 2026
We identified it
Jun 24, 2026
Summary
This is a new Medicaid policy for Louisiana covering breast surgery procedures including mastectomy, reconstruction, reduction mammoplasty, and implant removal. The policy establishes coverage criteria and medical necessity requirements for various breast surgery procedures effective May 18, 2026.
Action Required
Before May 18, 2026: Billing team must update Louisiana Medicaid breast surgery procedures to ensure medical necessity documentation meets new criteria. For reduction mammoplasty, verify 12-week symptom duration and macromastia diagnosis documentation. For risk-reducing mastectomy, confirm genetic testing or family history documentation. Update prior authorization processes for covered breast surgery codes to align with new coverage determination criteria.