Mastopexy, with or without breast implant insertion, including revisions of previous augmentation or mastopexy procedures done for cosmetic indications, is considered cosmetic and not eligible for benefit coverage.
For the associated policy related to insertion and/or removal of breast implants, please see Breast Implant, Removal and/or Insertion.
For assistance with mastopexy used in breast reconstruction management, refer to Reconstructive Mammaplasty and Contralateral Breast Surgery.
Disclaimer for coding information on Medical Policies
Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.
Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.