MedicaidCoverageMedium impact
Breast Procedures - MEDICAID - FLORIDA (Revised)
Humana·FL · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Dec 15, 2025
We identified it
Jun 24, 2026
Summary
Updated Medicaid coverage policy for breast procedures in Florida, establishing clear eligibility criteria for breast reconstruction, implant removal, and related procedures. The policy specifies covered indications including post-mastectomy reconstruction, trauma-related procedures, and certain breast implant complications.
Action Required
Before December 15, 2025: Billing team must update prior authorization and eligibility verification processes for Florida Medicaid breast procedure claims. Ensure documentation includes required medical necessity criteria (mastectomy/lumpectomy history, trauma within 12 months, or specific implant complications). Update billing system to flag liposuction-only reduction mammaplasty as non-covered. Provider staff should verify compliance with coverage limitations before scheduling procedures.