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[DOCX File]Surgery to Reduce the Risk of Breast Cancer (www.cancer ...
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The efficacy of this surgery for reduction of breast cancer risk is unparalleled. The National Cancer Institute says, “Bilateral prophylactic mastectomy has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a deleterious (disease-causing) mutation...and by up to 90 percent in women who have a strong ...

[DOCX File]VRSM C-700: Medical Services revised 082418
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C-703-4: Breast Reduction Surgery To be approved, macromastia must be determined to be a substantial impediment to employment. Before surgery can be considered, there must be documentation that less-invasive therapeutic measures were tried first, including proper brassiere support, prescription medication, and/or physical therapy.

Breast Procedures - Anthem
Procedure is to rebuild the normal contour of the contralateral unaffected breast to produce symmetry or a more normal appearance and involves (check all that apply): Reduction mammoplasty. Augmentation mammaplasty with implants. Mastopexy. Other (please describe): Member has had a mastectomy, lumpectomy or other breast surgery to treat breast ...

Mammapl crit v7
Reduction mammoplasty involves removal of glandular, fatty, and skin tissue from the breast. Women presenting various forms of breast hypertrophy (for example, macromastia or gigantomastia) accompanied by persistent clinical signs and symptoms that adversely affect health are the principal candidates for breast reduction.

Short Term Checklist - Mike Kreidler
Must provide coverage for reconstructive breast surgery resulting from a mastectomy that resulted from disease, illness or injury RCW 48.21.230(2) Coverage for all stages of one reconstructive breast reduction on the nondiseased breast to make it equal in size with the diseased breast after definitive reconstructive surgery on the diseased ...

[DOCX File]Maine Bureau of Insurance
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Coverage must be offered for breast reduction surgery and symptomatic varicose vein surgery determined to be medically necessary. ... This section establishes criteria defining who is an eligible domestic partner. ... All health insurance policies, health maintenance organization plans and subscriber contracts or certificates of nonprofit ...

[DOC File]CMN - Reduction Mammoplasty - Florida Health Insurance Plans
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Certificate of Medical Necessity Reduction Mammoplasty. Fax this completed Certificate of Medical Necessity form along with other required documentation including: symptoms and duration, patient’s height and weight, statement of anticipated amount of breast tissue to be removed per breast based upon body surface area in meters squared, documentation of conservative therapy and response (e.g ...

[DOC File]Breast Reduction Surgery - Department of Health
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All plans cover breast reduction surgeries that qualify under the Women’s Health and Cancer Rights Act of 1998. If a surgery does not qualify under the Women’s Health and Cancer Rights Act of 1998, some plans may allow breast reduction surgery if we determine the surgery will treat a physiologic functional impairment.

[DOCX File]Waiting Time and Elective Surgery Access Policy
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Waiting Time and Elective Surgery Access Policy. DGD16/015 Issue date: July 2016 ... a patient requesting breast reduction or abdominoplasty for severe intertrigo will need a letter from a dermatologist stating this procedure is clinically required to improve this patient’s health after failure of medical therapy, or documented evidence of ...

Reduction Mammoplasty - Anthem
Reduction is requested for: Poor posture. Breast asymmetry. Pendulousness. Problems with clothes fitting properly. Nipple-areola distortion. Psychological considerations. Request is for the use of liposuction to perform a breast reduction. Member’s height: Member’s weight: Size and shape of the breasts:

[DOC File]Florida Health Insurance Plans | Florida Blue
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Is reduction mammoplasty being performed: Yes No to correct a deformity resulting from a previous cosmetic surgery or procedure? If Yes, describe the procedure: Yes No using liposuction alone (instead of the standard surgical approach)? Yes No to alleviate symptoms caused by breast hypertrophy?

Guidelines for Medical Necessity Determination for ...
These Guidelines do not address excision of excessive breast tissue, i.e., mastopexy (CPT 19316), reduction mammaplasty (CPT 19318) or mastectomy for gynecomastia (CPT 19300). Providers should consult MassHealth regulations at 130 CMR 433.000 and 450.000, and Subchapter 6 of the Physician Manual for information about coverage, limitations ...

[DOC File]C&P Service Clinician's Guide - Veterans Affairs
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12. Breast: Describe masses, scars, nipple discharge, skin abnormalities. Give date of last mammogram, if any. Describe any breast surgery (with approximate date) and residuals. 13. Cardiovascular : NOTE: If there is evidence of a cardiovascular disease, or one is claimed, refer to appropriate worksheet(s). a.

Breast reduction surgery insurance criteria