Breast surgery - healthpartners

Breast reconstruction for poland syndrome. •. breast reduction ... malignant neoplasm of nipple and areola, right female breast. c50.012.
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Breast s urgeryThese services may or may not be covered by your HealthPartners plan. Please see your plan documents for yourspecific coverage information. If there is a difference between this general information and your plan documents, yourplan documents will be used to determine your coverage.Administrative ProcessPrior authorization is not required for:Breast reconstruction associated with mastectomy or lumpectomy (including surgery for•asymmetry)Breast reconstruction for Poland syndrome•Breast reduction•Prior authorization is required for:Augmentation mammoplasty not related to a mastectomy/lumpectomy•Mastopexy (breast lift) not related to a mastectomy/lumpectomy•Breast reconstruction to correct a congenital defect other than Poland syndrome•Breast implant removal and/or replacement not related to a mastectomy/lumpectomy•This policy does not address surgery for gynecomastia. Please see Related Content at right for link to coveragecriteria.CoverageBreast surgery is generally covere...
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