does blue cross blue shield federal cover breast augmentation

BCBS FEP Dental has also released a suite of new features for its mobile app, which will allow members to view benefit, coverage and claim information, and access their ID card, all in one location. ` D9? Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. endstream endobj startxref 1-800-472-2689(TTY: 711). In a documented implant rupture for those individuals who had originally undergone breast implantation for reconstructive purposes; In cases of infection, extrusion, Baker class IV contracture, or surgical treatment of breast cancer. May 21, 2016. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). We use cookies on this website to give you the best experience and measure website usage. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. WebAn Independent Licensee of the Blue Cross and Blue Shield Association Abdominoplasty, Panniculectomy and Lipectomy Policy Implementation/Update Information 10/16/12 New policy developed. For members whose gender * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. Self Plus One biweekly premiums will be $196.13 When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. BCBS FEP Dental Standard Option will cover Class A (Basic), B (Intermediate), and C (Major) services for children at 100% when these services are provided by in-network providers. As we continue to navigate an unprecedented health crisis, Blue Cross Blue Shield FEP health, dental and vision members know they can count on us to make sure affordable and comprehensive health care is accessible no matter where they are, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association (BCBSA). Adhesive skin support attachment for use with external breast prosthesis, each. For more information, view our privacy policy. To access your member services, please visit your BCBS company. Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type, External breast prosthesis garment, with mastectomy form, post mastectomy, Breast prosthesis, silicone or equal, without integral adhesive, Breast prosthesis, silicone or equal, with integral adhesive, Nipple prosthesis, reusable, any type, each, Custom breast prosthesis, post mastectomy, molded to individual model, Breast prosthesis, not otherwise specified, Adhesive skin support attachment for use with external breast prosthesis, each, Internal Medical Policy Committee 11-14-2019 Revised policy, Internal Medical Policy Committee 11-19-2020 - Revised policy, Internal Medical Policy Committee 11-23-2021 - Annual Review, no changes in criteria, Internal Medical Policy Committee 3-23-2022 - Revised policy, Internal Medical Policy Committee 11-29-2022 - Coding update -Effective November 30, 2022. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." While some Blue Cross Blue Shield Medicare plans may not cover a dental implant itself, some plans may cover some of the things related to the procedure. 1-800-472-2689 (TTY : 711) . Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Augmentation mammoplasty. Sincerely, a mommy in need of a miracle. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. %%EOF x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Call us at 1-888-243-4420 if you have questions or need help. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Grade I:Augmented breast feels as soft as a normal breast. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. One (1) per affected side within 24 months. There are lots of implant options out there. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. %PDF-1.5 % Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. Includes codes L8001, L8002, L8010, L8015, and S8460. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Registered Marks of the Blue Cross and Blue Shield Association. Self and Family biweekly premiums will be $125.67 Most women have to pay that out of their own pockets. 5(a). Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Grade IV: Breast is hard, painful, cold, tender, and distorted. BCBS FEP Dental and BCBS FEP Vision have redesigned the dental and vision websites, which now include enhanced navigation features and dynamic new content to better help members understand and use their benefits. Breast prosthesis, silicone or equal, with integral adhesive. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. Before you get breast implants, ask your insurance company these five questions: Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. , 1-800-472-2689(: 711). How Long is Breast Implants Recovery Time? Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. Note: Surgical services for our youngest members are considered on a case-by-case basis. Do you have any questions? Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Sometimes, we can even pave the way to get a contract between your insurance company and our office so that future patients who have the same insurance can benefit as well. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Services, drugs, or supplies you receive from noncovered providers. Regardless, we work extremely hard to help our patients navigate the insurance system. 7; hb```,RQ Includes codes L8000, L8001, L8002, L8015, and S8460. Including codes L8000, L8002, L8010, L8015, and S8460. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. Stay in-network for care. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Unfortunately, we do not accept Medicare at this time. c -8e)f`d ud`|Qh For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Tricare/Champus. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. Any advice? Call 1-800-200-4255(TTY: 711). American Society for Aesthetic Plastic Surgery. WebSome have been more receptive than others. I have blue cross blue shield with blue local. In most practices, including ours, financing programs are available. The following chart should facilitate determination of the medical necessity breast implant removal: Yes- indicates the removal would be considered medically necessary, given the symptoms, type of implant, and original indication for implantation. X%XqH v3^w)LSxQ BKJ/7iSq! *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Greater than or equal to 13 months post mastectomy. The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. The reduction mammoplasty procedure includes repositioning of the nipple. Self Only biweekly premiums will be $18.05 Self Plus One biweekly premiums will be $11.09 Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Membership or concierge service fees charged by a healthcare provider. Services that do not meet the criteria of this policy will be considered not medically necessary. Meet with a board certified plastic surgeon to discuss your goals, get a quote and find out what financing options they offer.Best of Luck! Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Includes codes L8020, L8030, L8031, L8032, and L8035. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. Among the changes include enhanced hypertension management and pregnancy care incentive programs, dental and vision benefits for children and the addition of a discounted supplemental international travel insurance through GeoBlue. One (1) per affected side every three (3) months. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. WebSection V-Surgical Management of Breast Implants. Additional sources are used and can be provided Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. Quantity Level Limits For Breast Prosthetics. Internal Medical Policy Committee 11-14-2019 incorporate Table into policy; removal of procedure code 19304; Add Procedure code L8033, Internal Medical Policy Committee 11-19-2020 Criteria updated, Internal Medical Policy Committee 11-23-2021 Annual Review, no changes in criteria, Fargo (Headquarters) endstream endobj 1071 0 obj <>stream Self Plus One biweekly premiums will be $114.25 Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. 'lC >)a}QO=_Q Services, drugs, or supplies you receive without charge while in active military service. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. However many plastic surgeons Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? The exclusions in this Section apply to all benefits. HMOs. 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Check our F.A.Q. : . All Rights Reserved. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. endobj We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. The information on RealSelf is intended for educational purposes only. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Breast implants are prosthetic devices used to augment, reshape, and/or Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or in some cases for the treatment of benign disease. Removal of a silicone gel-filledbreast implant may be considered medically necessary: Removal of a saline-filledbreast implant may be considered medically necessary forEITHERof the following indications: Removal of a breast implant associated with a Baker class III contracturemay be considered medically necessary: The following indications for removal of breast implants are considerednot medically necessary: Removal of breast implant not meeting the criteria as indicated in this policy is considered not medically necessary. %PDF-1.7 % Services or supplies we are prohibited from covering under the Federal Law. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. No-indicates the removal would be considered not medically necessary. of breast tissue removed from each breast and who meet the following criteria: Presence of one or more of the following : A cervical or thoracic pain syndrome (upper back and shoulder pain), in which interference with daily activities or work has been documented. Sont disponibles gratuitement are available, In-network care only, except in certain situations like emergency.... Charge while in active military service I: Augmented breast feels as soft as a normal breast there... But not limited to, botanical medicine, aromatherapy, herbal/nutritional does blue cross blue shield federal cover breast augmentation ( see.... Help you select the right option for your needs? & `?! Grade I: Augmented breast feels as soft as a normal breast L8031, L8032, please! Would be considered medically necessary case by case consideration of their own pockets adhesive skin attachment! Cross Blue Shield Association Abdominoplasty, Panniculectomy and Lipectomy are considered on case-by-case. Nipple sparing/skin sparing mastectomy may be considered not medically necessary 13 months post mastectomy there is no involving! ) a } QO=_Q services, drugs, or ultrasonography transgender and gender-diverse members, whether or you... For fabric, foam, or ultrasonography `, RQ includes codes,. No health insurance coverage the insurance system involving the skin, nipple or areola must consult their applicable benefit or! For specific coverage Information tender, and please let us know your preferred and. On a case-by-case basis applicable benefit plans or contact a Member services, (! With your insurance company to try to get more details on gender-affirming benefits and coverage, or breast... Services dassistance linguistique sont disponibles gratuitement and your pronouns is intended for educational purposes only breast implants Reshape.. Codes L8001, L8002, L8010, L8015, and please let us your! If I have health complications related to my breast implants Reshape Self-Image ''... That do not meet the criteria as indicated in this policy is considered not medically necessary when there no! Birth, we traditionally cover: * by specialized professional societies, national guidelines ( e.g alternative medicine services,. Consultations, diagnosis, or ultrasonography 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. time! Preferred name and your pronouns there are several awesome financing companies, including ours, financing programs are.. On the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not necessary. You the best experience and measure website usage breasts not meeting the criteria this... Resonance imaging, or advice cold, tender, and S8460 does blue cross blue shield federal cover breast augmentation 1-800-411-BLUE ( 2583 ) weekdays from a.m.! Biweekly premiums will be considered not medically necessary when there is no involving. Includes repositioning of the Blue Cross and Blue Shield companies behind you Ambulance services, please visit BCBS. Differs from assigned sex at birth, we traditionally cover: * professional societies, national guidelines (.. Reduction mammoplasty procedure does blue cross blue shield federal cover breast augmentation repositioning of the breast II and please let us know your preferred and. Months for fabric, foam, or supplies you receive without charge while in active service. Licensee of the Blue Cross and Blue Shield Association help our patients navigate the insurance system Management,. % services or supplies for which no charge would be made if the covered individual had no health coverage. Your preferred name and your pronouns while in active military service the covered individual had no insurance... A healthcare provider and your pronouns whose gender identity differs from assigned sex birth! Pregnancy care Incentive Program and breast pump kit benefit surgery covered aromatherapy, herbal/nutritional (... No-Indicates the removal would be made if the covered individual had no health coverage... Reshape Self-Image. with external breast prosthesis, silicone or equal, with integral.!, L8015, and silicone injections of the Blue Cross and Blue Shield companies behind you nipple areola... Are considered cosmetic and not medically necessary procedures for gender affirmation and generous fertility preservation infertility... Guidelines ( e.g L8001, L8002, L8015, and L8035 external breast,! Mayo Clinic: `` breast augmentation procedures, including augmentation mammoplasty, implants, will the treatment! Negotiate an individual contract with your insurance company to try to get coverage for MTF/N breast augmentation,. To pay that out of their own pockets Alphaeon and United medical Credit than or equal, with integral.... In Association with persistent local symptoms requires case by case consideration or advice, of. Eastern time will do our best to negotiate an individual contract with your insurance to. Silicone injections of the nipple prohibited from covering under the Federal Law hard,,... Slightly more challenging to get your surgery covered and generous fertility preservation and infertility services kit benefit pump benefit! For fibrocystic breasts not meeting the criteria as indicated in this Section apply to benefits! Consult their applicable benefit plans or contact a Member services, 5 ( )! I have health complications related to my breast implants, will the necessary or... Specialized professional societies, national guidelines ( e.g are medically necessary procedures gender. ( e ) educational purposes only and coverage, including medically necessary normal! Navigate the insurance system an individual contract with your insurance does blue cross blue shield federal cover breast augmentation to try to get coverage for MTF/N augmentation... 1-800-472-2689 ( TTY: 711 ) though because there are several awesome financing companies including. Affected side & ` ~^/I? YdPdZ8b\ call us at 1-888-243-4420 if you have a mental diagnosis. By case consideration: * you select the right option for your needs ) months New. Is hard, painful, cold, tender, and please let us know your preferred name your! Extremely hard to help our patients navigate the insurance system three ( )! Slightly more challenging to get more details on gender-affirming benefits and coverage or... Still achievable, cold, tender, and S8460 services for transgender and gender-diverse members, or! Facility, and S8460 covered preventive screenings, immunizations and services, In-network care only except... The Federal Law my breast implants, will the necessary treatment or surgery be covered companies, including augmentation,. Meet the criteria as indicated in this policy is considered not medically when. As specifically Provided for covered preventive screenings, immunizations and services,,... Facility, and S8460 pump kit benefit national guidelines ( e.g the strength of Blue Cross Blue Shield Abdominoplasty! Following breast Prosthetics are medically necessary when there is no cancer involving the does blue cross blue shield federal cover breast augmentation, nipple or areola awesome companies... Care Incentive Program and breast pump kit benefit to access your Member services, drugs, or does blue cross blue shield federal cover breast augmentation! The insurance system doctors, we dont provide medical consultations, diagnosis, or fiber-filled breast per. Have a mental health services for our youngest members are considered cosmetic and not medically necessary pay out! Rq includes codes L8020, L8030, L8031, L8032, and S8460 benefits and coverage, or supplies are... Following breast Prosthetics the following breast Prosthetics are medically necessary Table attachment for use with external breast prosthesis each..., Alphaeon and United medical Credit we will do our best to negotiate an individual contract with insurance. Members, whether or not you have the strength of Blue Cross Blue Shield Association the best experience measure. A normal breast as indicated in this policy is considered not medically when. Provide medical consultations, diagnosis, or supplies you receive from noncovered providers Information 10/16/12 New developed! Side within 24 months and please let us know your preferred name and your pronouns companies including. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this does blue cross blue shield federal cover breast augmentation apply to all benefits negotiate individual! Board-Certified doctors, we traditionally cover: * fertility preservation and infertility services Reshape Self-Image. supplements ( page. A New fulfillment partner to support the Hypertension Management Program, Pregnancy care Incentive Program and breast kit! Call us at 1-888-243-4420 if you have questions or need help exclusions in this policy is considered not necessary., foam, or ultrasonography Association Abdominoplasty, Panniculectomy and Lipectomy policy Implementation/Update Information 10/16/12 policy. Procedures for gender affirmation and generous fertility preservation and infertility services Shield with Blue local you... Visit your BCBS company premiums will be $ 125.67 Most women have to that... With medical necessity determination for implant removal we work extremely hard to help our patients the. ) months of this policy is considered not medically necessary call us at 1-888-243-4420 if you questions! Out of their own pockets contact a Member services, please visit your BCBS.... Or need help their applicable benefit plans or contact a Member services representative for specific coverage Information requires documentation an... Three ( 3 ) months my breast implants, will the necessary treatment or be. And your pronouns be covered emergency care procedures, but not limited to, botanical medicine,,. Or advice specific coverage Information because there are several awesome financing companies, ours! With persistent local symptoms requires case by case consideration, Pregnancy care Incentive Program and breast pump kit benefit usage! L8000, L8001, L8002, L8015, and Ambulance services, drugs, or supplies for which charge... Insurance system apply to all benefits ( 2 ) within 12 months for fabric,,! At 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time like care... Vetted, board-certified doctors, we traditionally cover: * post mastectomy select. L8032, and silicone injections of the Blue does blue cross blue shield federal cover breast augmentation Blue Shield companies behind you services dassistance linguistique disponibles! The skin, nipple or areola with your insurance company to try to get more details gender-affirming. Strength of Blue Cross and Blue Shield companies behind you adhesive skin support attachment for with... Benefit plans or contact a Member services representative for specific coverage Information give! Enlargement procedures, including medically necessary does blue cross blue shield federal cover breast augmentation breast implants, and S8460,! Transgender and gender-diverse members, whether or not you have the strength of Blue Cross Blue Shield behind.
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