Insurance Guide
Aetna often covers breast reduction and lift for patients with symptomatic macromastia, meaning large, heavy breasts that cause physical discomfort.
This guide explains Aetna’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 Aetna Clinical Policy Bulletin 0017, last reviewed March 12, 2026. Insurer policies change, and your plan documents control.
Aetna publishes its criteria in Clinical Policy Bulletin 0017. Aetna considers breast reduction medically necessary when all of the following are documented.
If you are 50 or older, Aetna also asks for a mammogram negative for cancer within the past two years.
Aetna does not use the Schnur scale. It uses its own table, based on body surface area calculated from height and weight, and its minimums are higher.
Minimum tissue removal per breast. Because Aetna's numbers differ from the Schnur scale, our team checks your measurements against Aetna's table before your consultation. Compare with the Schnur scale and calculator.
Dr. Kiwanuka works with Aetna 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 Aetna's criteria.
Our team
We submit your request to Aetna 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. Aetna covers breast reduction when it is medically necessary: breasts large enough to cause physical symptoms that have not improved with treatment. Your symptoms, photographs, and the amount of tissue to be removed must meet Aetna's policy, and your plan must include the benefit.
Aetna Clinical Policy Bulletin 0017 asks for age 18 or stable breast size; symptoms in at least two areas for at least one year; at least 3 months of treatment without relief; color photographs from the front and side; tissue removal at or above Aetna's table for your body surface area or more than 1 kg per breast; and, at 50 or older, a recent negative mammogram.
No. Aetna uses its own table based on body surface area, and its minimums are higher than the Schnur scale. More than 1 kg per breast qualifies at any size. Our team checks your numbers against Aetna's table for you.
Aetna asks for at least 3 months of documented treatment before surgery, such as pain medication, physical therapy, supportive bras, chiropractic care, or a medically supervised weight loss program.
Yes, if you are 50 or older. Aetna asks for a mammogram negative for cancer within the two years before surgery.
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 Aetna 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 Aetna, 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.