A health care professional must provide evidence of medical necessity for the cost of a breast reduction to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement.
Note: A breast reduction for the sole purpose of improving appearance is not an eligible expense.
The cost of breast reconstruction surgery following a mastectomy is an eligible medical expense.
The cost to purchase or rent a breast pump is an eligible medical expense.
The cost to replace a cosmetic implant (i.e. reduction or enlargement) is not an eligible medical expense.
A health care professional must provide evidence of medical necessity for the cost of breast implants or removal to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement.
