PROCEDURE PLAYBOOK · PLASTIC & RECONSTRUCTIVE SURGERY

How to appeal a Breast Reduction (Reduction Mammaplasty) denial

Breast-reduction denials are the reconstructive-vs-cosmetic fight: payers deny 19318 as cosmetic unless documented symptoms, a minimum grams-per-side resection (often the Schnur scale), and failed conservative measures meet the medical-necessity policy.

Common code: CPT 19318 (reduction mammaplasty)

Why it gets denied

  • The payer denied it as cosmetic without documented symptomatic macromastia
  • The estimated or actual grams removed didn't meet the payer's body-surface-area (Schnur) threshold
  • Failed conservative care (support, PT, dermatologic treatment) wasn't documented
  • Prior authorization was missing

What overturns it

  • Document the symptoms (back/neck/shoulder pain, intertrigo, grooving) and the failed conservative measures the policy requires
  • Submit the resection weight meeting the Schnur/BSA threshold with the pre-op estimate
  • Obtain prior auth and tie the functional documentation to it
  • Include photographs where the policy requests them

Worth appealing? Reduction mammaplasty is a high-dollar surgery routinely denied as cosmetic, and it's recoverable when the symptom history, conservative-care trial, and resection weight are documented to the reconstructive criteria.

Common questions

How do I appeal a Breast Reduction (Reduction Mammaplasty) denial?

Breast-reduction denials are the reconstructive-vs-cosmetic fight: payers deny 19318 as cosmetic unless documented symptoms, a minimum grams-per-side resection (often the Schnur scale), and failed conservative measures meet the medical-necessity policy. To overturn it: document the symptoms (back/neck/shoulder pain, intertrigo, grooving) and the failed conservative measures the policy requires; submit the resection weight meeting the Schnur/BSA threshold with the pre-op estimate; obtain prior auth and tie the functional documentation to it; include photographs where the policy requests them.

Why do Breast Reduction (Reduction Mammaplasty) claims get denied?

The payer denied it as cosmetic without documented symptomatic macromastia; The estimated or actual grams removed didn't meet the payer's body-surface-area (Schnur) threshold; Failed conservative care (support, PT, dermatologic treatment) wasn't documented; Prior authorization was missing.

Is a Breast Reduction (Reduction Mammaplasty) denial worth appealing?

Reduction mammaplasty is a high-dollar surgery routinely denied as cosmetic, and it's recoverable when the symptom history, conservative-care trial, and resection weight are documented to the reconstructive criteria. You pay 25% only on what's recovered, so there's no cost to working the winnable ones.

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