CommercialAdministrativeLow impact
11.08.12i, Surgery for Gynecomastia
Independence Blue Cross·Plastic Surgery, General Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
This is a routine annual reissue of Independence Blue Cross policy 11.08.12i with no substantive changes to coverage criteria, medical necessity requirements, or billing codes. The policy maintains coverage for CPT 19300 (mastectomy for gynecomastia) and CPT 19318 (reduction mammoplasty), while CPT 15877 (suction-assisted lipectomy) remains experimental/investigational.
Action Required
No immediate action required. This is a reissue with no changes to coverage criteria, coding, or documentation requirements. Billing team should verify current systems already reflect: CPT 19300 and 19318 as covered (medically necessary when criteria met), CPT 15877 as non-covered (experimental/investigational), and ICD-10 N62 for gynecomastia claims. No workflow modifications needed unless previous guidance differed from current policy language.