Breast surgery is no long and exception in regards to Medicare reimbursement rates according to new research, via General Surgery News.
Breast reduction surgery, which is also known as reduction mammaplasty, involves removing skin and tissue from the breasts, then reshaping them to a smaller size, a surgery that has been on the rise since the pandemic as those surgeries that were not considered medically necessary and were paid for out of pocket increased by 54% from 2019 to 2022, according to the American Society of Plastic Surgeons (ASPS).
In the past, in order to obtain coverage for breast reduction surgery through Medicare or Medicare Advantage, the procedure needs to be medically necessary, and not to be done simply for cosmetic.
Additionally, it needs to meet the following criteria.
- To reduce decrease or eliminate symptoms caused by breast size
- To reduce the size of a breast to make it symmetrical with a breast reconstructed after breast cancer surgery
The Centers for Medicare & Medicaid Services (CMS) have outlined the following as well:
- Surgeons must make sure that patients have tried non-surgical interventions to alleviate breast pain or chafing, such as chiropractic care, physical therapy, and dermatologic treatments
- The symptom(s) must have been present for a minimum of six months
- Interventions and medical treatment were not able to alleviate symptoms adequately
- The patient has been notified of the risks of complications
- The notes indicate the proposed amount of tissue to be removed and the rationale supporting that determination
But a new report shows data that suggests medicare reimbursement for breast surgery is showing a steady decline, and the impact on the folks who need the surgery and the plastic surgeons who provide it is being felt.
Read the article for more information.
