Does Medicare cover breast reduction surgery?
I assume the answer is no, but are there any circumstances where Medicare would cover a breast reduction? I suffer from severe back pain and I know it’s because of my DDDs. I don’t have the money to cover surgery on my own. What can I do?
Some insurances cover breast reduction. Third party payers typically have the doctor take pictures and a medical history, and submit these for something called "preauthorization." If pre-authorized, the insurance says they will pay for the procedure (less copays, deductibles and co-insurance fees paid by the patient). However, Medicare does not have a pre-auth pathway. In such situations, the surgeon can perform the surgery and bill Medicare but there is a chance the surgeon won't get paid. For this reason, most surgeons have you fill a "Medicare waiver" and/or pre-pay for the procedure. If Medicare covers, then your fee is refunded and the Medicare assignment is accepted. Because of this hassle factor, you may find some plastic surgeons won't see new Medicare patients for this operation.
-- Dr. Sayed
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