Table 2.

Medical Necessity Criteria as Described by Policies of Included Third-party Payers

Insurance Provider	Age of Patient or Timing	No. Symptoms Required for Coverage	Timing of Symptoms	Conservative Therapy Required	Photographs Required	Tissue Resection Weight Requirement	Postoperative Pathology	Liposuction Only	Cosmetic Designation when:
United Health Care	Not mentioned	Not clearly delineated	Not mentioned	Not mentioned	No	Yes	Not mentioned	Not covered	Surgery affects appearance but fails to improve function
Aetna	Must be 18 y or have completed breast growth (defined)	2	1 y	Yes	Yes	Yes	Not mentioned	Not covered as experimental	Asymptomatic patients
Cigna	Must be 18 y or have completed breast growth (not defined)	1	Not mentioned	Not mentioned	Yes	Yes	Not mentioned	Not covered as unproven	For appearance or psychosocial benefits
BCBS of Florida	Not mentioned	2	6 wk	Yes	Yes	Yes	Not mentioned	Not covered as experimental	Medical necessity criteria not met or correction of previous cosmetic surgery
BCBS of New York	Not mentioned	1	3 mo	Yes	May be requested	Yes	Not mentioned	Not covered as not medically necessary	Poor posture, breast asymmetry, pendulousness, clothes fitting improperly, nipple-areola distortion
BCBS of Texas	Must be 18 y or older	3	6 wk	Yes	Yes	Yes	May be requested	Not covered as experimental/unproven	For appearance or psychosocial benefits
BCBS of California	Not mentioned	1	6 wk	Yes	Yes	Yes	Not mentioned	Not explicitly stated but treatments not discussed are considered investigational	Medical necessity criteria not met