![]() ![]() Part Bĭoctors perform some breast reconstruction and reduction surgeries on an outpatient basis, such as the implantation of a breast prosthesis following the removal of a breast due to cancer. A person’s share of the costs would include a $1,484 deductible for each benefit period and $0 coinsurance for the first 60 days of each benefit period.Ī benefit period begins the day an individual enters a hospital and ends the day after they have been out of the hospital for 60 consecutive days. Part A, Medicare’s hospitalization insurance, covers inpatient surgeries. The alternative to original Medicare, Part C, also provides coverage. A person with original Medicare, which includes Part A and Part B, gets coverage and may have additional help if they have Part D and Medigap. How much does Medicare pay for breast reduction surgery?įor breast reconstruction surgeries that meet the coverage criteria, different parts of Medicare help cover the expenses. If a person wants a breast reduction procedure that Medicare does not cover, they must pay 100% of the cost. ![]() A person will need to contact Medicare to find out how their local MAC may cover gender-affirming surgeries.Īccording to a 2020 study in Plastic and Reconstructive Surgery, the average outpatient cost of breast reduction is $9,077, while the average inpatient cost is $19,975. ![]() If a person desires breast reduction as a part of gender-affirming interventions, Medicare’s decision on whether to cover the surgery will be on a local Medicare Administrative Contractors (MAC) basis. A person may need to prove that they have been experiencing symptoms for at least 6 months and that nonsurgical treatments have not been effective. severe back, neck, or shoulder pain due to excessively large breastsĪ person’s doctor would need to certify the surgery is medically necessary for Medicare to cover the surgery.postural changes resulting from very heavy breasts.chronic skin infections under the breast tissue.Some examples of medical circumstances in which Medicare may pay for reduction surgery include: Medicare will pay for breast reduction surgery for those who experience medical side effects due to excessively large breasts. When the purpose of breast reduction surgery is purely cosmetic, such as when a person wants to reduce the size of their breasts only for aesthetic reasons, Medicare does not cover the procedure. Share on Pinterest Thierry Dosogne/ Getty Images ![]()
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