I am asked this all the time, so here is the short answer: yes, breast reduction surgery can sometimes be covered by insurance.
The key is showing that your breast size is causing a medical problem, not simply that you want smaller or more lifted breasts.
If you are experiencing neck, shoulder or back pain, bra-strap grooving, recurrent rashes, or other physical symptoms, come see us. We can evaluate you and review what your insurance plan requires.
Connect with our Patient Care Coordinator to assess your options at (805) 777-3877
What Does Insurance Look For?
Every insurance plan is different, but most want documentation showing that your breast size is causing ongoing physical symptoms.
They may look for:
- Neck, shoulder or upper back pain
- Bra-strap grooving
- Recurrent rashes beneath the breasts
- Numbness or tingling
- Previous nonsurgical treatment, such as supportive bras, medication or physical therapy
- Photographs and an estimate of how much breast tissue will be removed
The procedure code for breast reduction is CPT 19318, and breast hypertrophy is commonly documented as ICD-10 N62.
The important part is making sure your symptoms, examination and proposed surgery support medical necessity.
How Much Tissue Needs to Be Removed?
Insurance companies may require us to estimate how many grams of breast tissue will be removed. Some plans compare this with your body surface area or use criteria such as the Schnur scale.
There is no single number that applies to everyone. Your insurance policy determines what is required.
What About a Breast Lift?
This is where the distinction matters.
A breast reduction removes breast tissue to reduce breast size and may qualify for insurance coverage when it is medically necessary.
A breast lift primarily reshapes and lifts the breasts without removing a significant amount of tissue. By itself, it is almost always considered cosmetic.
Can We Help With Insurance?
Yes. For patients considering breast reduction in Thousand Oaks, the Conejo Valley and surrounding Ventura County communities, we can evaluate your symptoms and review your insurance requirements before moving forward.
Connect with ust before your consultation to verify insurance information and any records showing previous treatment for neck, shoulder or back pain, rashes, or other symptoms.
We will look at the requirements together and determine whether pursuing insurance authorization makes sense.
If large breasts are causing pain or interfering with your daily life, schedule a consultation with Dr. Gil Kryger or Dr. Zol Kryger to find out whether breast reduction — and potential insurance coverage — may be an option for you.