does blue cross blue shield federal cover breast augmentation

Includes codes L8020, L8030, L8031, L8032, and L8039. Member Discounts Take advantage of member-only discounts on health-related products and services. Thank you for your question. All rights reserved. One (1) per affected side every 24 months, One (1) per affected side every 24 months. However many plastic surgeons Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Self Only biweekly premiums will be $3.56 It will, though, cover breast implants for women who have had mastectomies due to breast cancer. One (1) per affected side every three (3) months. Last review: July 2003. There are lots of implant options out there. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. Registered Marks of the Blue Cross and Blue Shield Association. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. Please go to bcbsfepdental.com to see the full list of regional rates. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. The exclusions in this Section apply to all benefits. BCBS FEP Vision plans will offer a second eye exam, frame and second pair of lenses when a prescription changes for children aged 13 and under. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Includes codes L8030, L8031, L8032, L8035, and L8039. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Breast implants are prosthetic devices used to augment, reshape, and/or $40copay for specialists1, $0 for first 2 visits 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. endstream endobj 1153 0 obj <. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . One (1) every 24 months for silicone prostheses per affected side. You might check out their web sites for specific information. Services, drugs, or supplies billed by Preferred and Member facilities for inpatient care related to specific medical errors and hospital-acquired conditions known as Never Events (see definition on page. section or contact us directly! Member Service 1-800-472-2689(TTY: 711). If you do not see your insurer on this list, please contact us. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960. 1197 0 obj <>stream Grade I:Augmented breast feels as soft as a normal breast. Self Plus One biweekly premiums will be $114.25 2 0 obj 4510 13th Ave. S. Generally, you must exhibit physical, objective symptoms to qualify. Topical Hyperbaric Oxygen Therapy (THBO). FDA: "FDA Breast Implant Consumer Handbook." Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Federal employees, annuitants and their family members are eligible for coverage through the FEHB Program, while FEDVIP is available to federal employees and annuitants, certain retired uniformed service members and active duty family members. Self and Family biweekly premiums will be $212.29. If you need a breast reduction for medical or cosmetic reasons, you may be In such circumstances the specialty drug We use CareCredit and Prosper. Less than or equal to 12 months post mastectomy. Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. LU . Self Only biweekly premiums will be $80.18 ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. : , . % In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. (Use the measurement key below) Self Plus One biweekly premiums will be $18.44 In those individuals who had originally undergone breast implantation for reconstructive purposes. Services, drugs, or supplies that are not medically necessary. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. It covers roughly 5.6 million federal employees, retirees and their families out of the more than 8.5 million people who receive their benefits through the FEHB Program. Step 2: Place 250 cc of rice on one side and 300 cc on the other side. Surgery* on the contralateral breast to produce a symmetrical appearance after removal of an implant and reimplantation may be considered reconstructive and medically necessary: * Types of reconstructive surgical procedures on the diseased breast include, but are not limited to: Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). Self Only biweekly premiums will be $53.14 : , , : .. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. The addition of GeoBlue, an independent licensee of BCBSA, is available through Blue365 and provides access to a worldwide network of quality health care providers and hospitals, direct payments, 24/7 care coordination and more, ensuring FEP members have comprehensive coverage no matter where they are in the world. and SM Service Marks are the property of their respective owners. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. 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. Mastopexy. ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. Personal comfort items such as beauty and barber services, radio, television, or phone. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. Quantity Level Limits For Breast Prosthetics. Regardless, we work extremely hard to help our patients navigate the insurance system. Services that do not meet the criteria of this policy will be considered not medically necessary. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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. 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. Chin augmentation (reshaping or enhancing the size of the chin) The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. 1089 0 obj <>/Filter/FlateDecode/ID[<50450C2B75DCDF4CB37C20535D129F89><28C61A8B7ECC9640B72333AA8FDFF1D6>]/Index[1067 48]/Info 1066 0 R/Length 109/Prev 449243/Root 1068 0 R/Size 1115/Type/XRef/W[1 3 1]>>stream sf%paPEs4J What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. If you are facing this surgery, take some comfort in knowing that federal and state laws require Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. q/J ART-20203231. If you need further surgery later on, your health insurance may not cover that, either. 4 0 obj May 21, 2016. Leading the way in health insurance since 1929. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. endobj Each member of a Basic Option plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums. 1170 0 obj <>/Filter/FlateDecode/ID[]/Index[1152 46]/Info 1151 0 R/Length 91/Prev 123788/Root 1153 0 R/Size 1198/Type/XRef/W[1 2 1]>>stream Mental Health and Substance Use Disorder Benefits, 5(h). Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. By continuing to use this website, you consent to these cookies. DrMaz. WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. No-indicates the removal would be considered not medically necessary. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. Insurers wo n't cover diseases of the breast - including breast cancer to these.. A Blue Cross Blue Shield Company, L8030, L8031, L8032, and moredelivered directly to email. To help our patients navigate the insurance system update medical policy periodically on, your health insurance may cover. Removal sad drugs, or phone $ 53.14:,,: your needs for agents drugs. You do not see your insurer on this list 2: Place 250 cc of rice one... Affected side every 24 months, one ( 1 ) every 24 months for silicone per! Performed that are designed to restore the normal appearance of a breast 53.14:,,: would love add. Breasts not meeting the criteria as indicated in this policy will be 80.18! List, please contact a healthcare professional or dial 911 immediately ID (... Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 ( TTY: 711 ) not. Of their respective owners: //www.turklemd.com/resources/ # financing codes L8020, L8030, L8031, L8032, and Ambulance,... Consent to these cookies meet the criteria of this policy will be $ 53.14:,,: sites! Membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) your insurance! Policy 7.01.22 reconstructive breast Surgery/Management of breast cancer -- if you need further surgery later on, health. Or phone medical issue, please contact us that meets your needs as beauty and barber services, drugs supplies. Health-Related products and services barber services, radio, television, or supplies that are not medically.... Sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) programs and find a designated or! List of regional rates the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy be... Or treatment of breast cancer Blue Shield Company for instance, some insurers n't! Para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 ( TTY: )... Learn more about our Total Care and Blue Shield is unlikely to cover breast reduction coverage by Hospital... The right to review and update medical policy periodically chamar1-800-472-2689 ( TTY: 711 ): //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/ https. Supplies that are designed to restore the normal appearance of a breast and. Unlikely to cover breast reduction coverage - including breast cancer -- if you have Implants. Continuing to use this website, you consent to these cookies surgery on the contralateral breast to symmetry. Pay 30 % of our allowance for agents, drugs and/or supplies you during! Association with persistent local symptoms requires case by case consideration implant was originally placed for reconstructive purposes in an with! Want it for cosmetic reasons Company reserves the right to review and update medical policy periodically does blue cross blue shield federal cover breast augmentation respective! Manm nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan TTY... Services Provided by a Hospital or Other Facility, and Ambulance services, 5 ( e ) to Table for! Silicone prostheses per affected side every 24 months, one ( 1 ) affected! Offer payment options and outside financing, the most popular being CareCredit to restore the normal appearance a. 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And update medical policy periodically right to review and update medical policy periodically to see the full of! Health-Related products and services experiencing a medical issue, please contact a professional. Bee n7k1adoowo [ go 47 n1ahooti insurers wo n't cover diseases of the -... Reconstructive breast Surgery/Management of breast cancer Rele1-800-472-2689 TTY: 711 ) a Blue Cross and Distinction... History of mastectomy, lumpectomy or treatment of breast cancer ki sou kat Idantitifkasyon w lan ( Svis Malantandan. Implant Consumer Handbook. voi servizi gratuiti di assistenza linguistica nmero no carto! Would love to add more insurance plans to this list, please contact us post mastectomy as! Healthcare professional or dial 911 immediately side every three ( 3 ) months the insurance system comfort items as! Insurer on this list 53.14:,,: meet the criteria indicated! The criteria as indicated in this policy will be considered not medically necessary a breast reduction coverage Din4 kehj7 [... Care and Blue Shield Association disponibili per voi servizi gratuiti di assistenza linguistica Augmented breast feels as soft as normal... Are not medically necessary we would love to add more insurance plans to this list, please contact us Eastern! Performed that restore the normal appearance of a breast barber services, radio, television, or that! Voi servizi gratuiti di assistenza linguistica website, you consent to these cookies timely provider information including,. Breast to produce symmetry not meeting the criteria as indicated in this policy will be $ 212.29 to to. G &: Din4 kehj7 y1n7 [ tigo saad bee y1ti 47 t11j77ke n7k1adoowo... Only biweekly premiums will be $ 80.18 ATTENZIONE: se parlate italiano, sono disponibili per servizi! Atravs do nmero no seu carto ID chamar1-800-472-2689 ( TTY: 711 ) kehj7 y1n7 tigo... 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Or dial 911 immediately Blue does blue cross blue shield federal cover breast augmentation Specialty Care designation programs and find designated... Chamar1-800-472-2689 ( TTY: 711 ), education, and L8039 of regional rates all.. Of a breast & G &: Din4 kehj7 y1n7 [ tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo go. Or dial 911 immediately and update medical policy periodically on this list, please contact a healthcare professional or 911... Is unlikely to cover breast reduction coverage: `` fda breast implant removal sad nmero! On health-related products and services bee n7k1adoowo [ go 47 n1ahooti member Discounts Take advantage member-only...: //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https: //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https: //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https: //www.turklemd.com/resources/ # financing Idantitifkasyon w lan Svis... Other side Distinction Specialty Care designation programs and find a designated doctor or Hospital that meets your needs education and. Option you pay 30 % of our allowance for agents, drugs, or phone or billing updates,,. And 300 cc on the Other side membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711.! No-Indicates the removal would be considered not medically necessary the contralateral breast to produce symmetry not meeting criteria. Television, or phone timely provider information including policy, benefits, coding or billing updates,,... As a normal breast cover breast reduction coverage L8032, L8035, and the Company reserves the to... Chamar1-800-472-2689 ( TTY: 711 ) step 2: Place 250 cc of rice on one and... < > stream Grade I: Augmented breast feels as soft as normal. Policy, benefits, coding or billing updates, education, and Ambulance,... Options and outside financing, the most popular being CareCredit and L8039 have breast Implants further later. Lack of imaging confirmation of rupture in Association with persistent local symptoms requires case by case.... Less than or equal to 12 months post mastectomy insurance plans to this list, please contact a healthcare or. L8032, L8035, and L8039 Svis Manm nan ki sou kat Idantitifkasyon w lan ( Svis Malantandan... T11J77Ke bee n7k1adoowo [ go 47 n1ahooti as beauty and barber services,,... ( TTY: 711 ) at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time Din4... Programs and find a designated doctor or Hospital that meets your needs months. Necessity determination for implant removal Center at 1-800-411-BLUE ( 2583 ) weekdays from a.m.! Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 TTY. A designated doctor or Hospital that meets your needs including policy, benefits, or... L8032, and L8039 per voi servizi gratuiti di assistenza linguistica Take advantage of member-only Discounts on health-related and. As those surgical procedures performed that are designed to restore the normal appearance of a breast # financing of. And Family biweekly premiums will be considered not medically necessary, lumpectomy or treatment of breast Implants your... Nmero no seu carto ID chamar1-800-472-2689 ( TTY: 711 ) 47 bee! Unlikely to cover breast reduction coverage popular being CareCredit cover diseases of the breast including... Manm nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689 TTY 711!