Insurance Guide
UnitedHealthcare 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 UnitedHealthcare’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 UnitedHealthcare Medical Policy MP.004.32, effective June 1, 2026. Insurer policies change, and your plan documents control.
UnitedHealthcare Medical Policy MP.004.32, Breast Reduction Surgery, decides coverage in two steps: whether your plan includes breast reduction, and whether your surgery is medically necessary.
Because the full criteria are not public, our team checks your plan language first and prepares documentation for the review your plan uses.
UnitedHealthcare 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 UnitedHealthcare rule. See the full Schnur scale and calculator.
Dr. Kiwanuka works with UnitedHealthcare 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 UnitedHealthcare's criteria.
Our team
We submit your request to UnitedHealthcare 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. UnitedHealthcare 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 UnitedHealthcare uses.
UnitedHealthcare Medical Policy MP.004.32 refers medical necessity reviews to InterQual criteria. Requests are typically supported by documented symptoms caused by breast size, records of treatment you have tried, clinical photographs, and the planned tissue removal for your body size.
UnitedHealthcare does not publish a tissue table. Its reviews use InterQual criteria, which are licensed rather than public. The Schnur scale is a useful guide to where you may fall, but it is not a published UnitedHealthcare rule.
InterQual is a licensed set of clinical criteria that many insurers use to review requests. UnitedHealthcare uses it for breast reduction, and the full criteria are not published, which is why our team prepares documentation that covers symptoms, treatment history, photographs, and planned tissue removal.
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 UnitedHealthcare 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.
UnitedHealthcare does not publish a fixed treatment period. 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 UnitedHealthcare, 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.