Reduction mammaplasty may be considered medically necessary for the treatment of macromastia when well-documented clinical symptoms are present, including but not limited to:
· Documentation of a minimum 6-week history of shoulder, neck, or back pain related to macromastia not responsive to conservative therapy, such as an appropriate support bra, exercises, heat/cold treatment, and appropriate nonsteroidal anti-inflammatory agents or muscle relaxants; OR
· Recurrent or chronic intertrigo between the pendulous breast and the chest wall.
Reduction mammaplasty is considered investigational for all other indications not meeting the above criteria.
