Billing Process for Reduction Mammoplasty Corrected

TRICARE policy allows for the approval of reduction mammoplasty, a procedure to remove breast tissue, when signs and symptoms are present in at least two anatomical locations, daily activity has been affected for at least one year and is related to the size of the breasts. These need to be documented in the medical record. All authorization requests for reduction mammoplasty require medical review.

Wisconsin Physicians Services (WPS) recently made a system correction regarding bilateral procedures in breast reductions. Providers now should bill the proper procedure code with one line with Modifier 50 with one unit to be paid appropriately.