Insurance Guide
Oxford may cover breast reduction and lift for patients with symptomatic macromastia, meaning large, heavy breasts that cause physical discomfort, when your plan includes the benefit.
This guide explains Oxford’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.
Based on UnitedHealthcare Medical Policy MP.004.32, effective June 1, 2026. Insurer policies change, and your plan documents control.
Oxford Health Plans is part of UnitedHealthcare. Coverage for breast reduction depends on two things: whether your Oxford plan includes the benefit, and whether your surgery is medically necessary.
We check your plan language, referral rules, and out of network benefits before you book.
Oxford does not publish a tissue table. Requests are reviewed against InterQual criteria, which are licensed rather than public. The Schnur scale is a useful guide to where you may fall.
Schnur scale reference at the 22nd percentile, per breast. These values are a guide only and are not a published Oxford or UnitedHealthcare rule. See the full Schnur scale and calculator.
Dr. Kiwanuka works with Oxford 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 Oxford's criteria.
Our team
We submit your request to Oxford 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.
It depends first on your plan. Oxford is part of UnitedHealthcare, which states that most of its plans exclude breast reduction except where required by law, while some cover it when it treats a physical functional impairment. When your plan includes the benefit, coverage depends on meeting the clinical criteria used for the review.
Oxford Health Plans is part of UnitedHealthcare. Oxford plans have their own networks, referral rules, and plan documents, so we check your specific Oxford plan rather than assuming it matches another UnitedHealthcare plan.
No tissue table is published for Oxford plans. Reviews use licensed InterQual criteria. The Schnur scale is a useful guide to where you may fall, but it is not a published Oxford rule.
Some Oxford plans require a referral from your primary care physician, and not every Oxford plan includes out of network benefits. We check both during your free insurance verification.
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 Oxford 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.
No fixed treatment period is published. Records of what you have tried, such as physical therapy, supportive bras, pain medication, or treatment for rashes, strengthen your request.
We review the reason and, when appropriate, send more documentation or an appeal. You also have appeal rights through Oxford, 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.