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Reduction Mammoplasty Criteria Update (New Requirements)

Reduction Mammoplasty Criteria Update (new requirements for <40 years of age):

Reduction Mammoplasty and Gynecomastia Surgery Policy CP.MP.51 went through annual review in August 2024.

NEW CRITERIA: For individuals <40 years of age with symptoms or high-risk factors for breast cancer, a mammogram must be performed within the year prior to the date of the planned reduction mammoplasty procedure with negative results.

Therefore, effective October 21, 2024, the following criteria will apply:

  • < 40 years of age with symptoms of breast cancer or high-risk factors for breast cancer and mammogram negative for cancer performed within the year prior to the date of the planned reduction mammoplasty procedure
  • < 40 years of age with no symptoms of breast cancer and no high-risk factors for breast cancer

You can review this policy on the Meridian website, Clinical & Payment Policies page here: Meridian Clinical & Payment Policies

Last Updated: 09/26/2024