Insurance Guide
Cigna often covers breast reduction and lift for patients with symptomatic macromastia, meaning large, heavy breasts that cause physical discomfort.
This guide explains Cigna’s medical necessity requirements for breast reduction, how much breast tissue may need to be removed, and how we handle insurance preauthorization for breast reduction and lift at Kiwanuka Plastic Surgery in New York City.
Summarized from Cigna Medical Coverage Policy 0152, effective November 15, 2025. Insurer policies change, and your plan documents control.
Cigna publishes its criteria in Medical Coverage Policy 0152, Reduction Mammoplasty for Macromastia. Cigna considers breast reduction medically necessary when all of the following are documented.
Cigna's policy does not set a fixed period of prior treatment and does not list a mammogram requirement. It also states that your plan documents take priority over the policy.
Cigna uses the Schnur scale, a chart that pairs your body surface area, calculated from height and weight, with a reference amount of tissue removed per breast. Your planned reduction must be above the 22nd percentile for your size.
Minimum tissue removal per breast at the 22nd percentile of the Schnur scale. Our team checks your measurements against Cigna's criteria before your consultation. See the full Schnur scale and calculator.
Dr. Kiwanuka works with Cigna members through their out of network benefits. More than 95% of the insurance requests we submit are approved. Here is how the process works.
Our team
We check your plan's out of network benefits, deductible, coinsurance, and referral rules at no cost.
You and Dr. Kiwanuka
Dr. Kiwanuka examines you and plans your reduction. Consultations are complimentary for insurance patients.
Our team
Clinical photographs, records of prior treatment, and a letter of medical necessity written to Cigna's criteria.
Our team
We submit your request to Cigna and follow up until a decision is made.
All patients photographed with informed written consent. Individual results vary and are dependent on anatomy, procedure type, and recovery.
Often, yes. Cigna covers breast reduction when it is medically necessary for symptomatic macromastia: breasts large enough to cause physical symptoms. Your symptoms, photographs, and the amount of tissue to be removed must meet Cigna's policy, and your specific plan must include the benefit.
Cigna Medical Coverage Policy 0152 asks for age 18 or completed breast growth; neck, shoulder, or upper back pain, ulnar nerve symptoms, or skin conditions beneath the breasts that have not responded to medical treatment; photographs confirming breast size and bra strap grooving or rashes; and tissue removal above the 22nd percentile of the Schnur Sliding Scale or more than 1 kg per breast.
Yes. Cigna uses the 22nd percentile of the Schnur Sliding Scale, based on body surface area. Removal of more than 1 kg per breast qualifies regardless of body size. You can check your number with our Schnur scale calculator.
Cigna's policy asks that your symptoms have not responded to medical management, and it does not set a fixed number of weeks or months. Records of what you have tried, such as physical therapy, supportive bras, pain medication, or treatment for rashes, strengthen your request.
Cigna's breast reduction policy does not list a mammogram requirement. Dr. Kiwanuka follows standard screening guidelines for your age and history.
Yes. Every breast reduction reshapes the breast and moves the nipple higher, so the lift is part of the operation. A lift on its own, without a reduction, is generally considered cosmetic.
Dr. Kiwanuka works with Cigna members through their out of network benefits. Benefits vary by plan, and our team checks yours for free before you schedule. You may request a written estimate of what we will bill at any time.
We review the reason and, when appropriate, send more documentation or an appeal. You also have appeal rights through Cigna, and some denials qualify for an independent external review.
Share a few details and our team will check your breast reduction benefits at no cost and with no obligation. Prefer to write? Contact us.
Verification confirms your benefits. It is not a guarantee of coverage or payment.