Louisiana New Breast Reconstruction Post Mastectomy Policy 2016

Louisiana Department of Health
Health Plan Advisory 16-25
Revised September 23, 2016
New Breast Reconstruction Post Mastectomy Policy
This advisory provides notification of changes in coverage of Breast Reconstruction Post Mastectomy.
Historically, Louisiana Medicaid only covered breast reconstruction post mastectomy on the affected/diseased
breast. Effective with dates of service October 1, 2016 and forward, Medicaid fee – for – service will now cover
breast reconstruction post mastectomy of the contralateral unaffected breast to achieve symmetry
for patients diagnosed with breast cancer.  Medicaid fee Рfor Рservice will also cover additional services for reconstruction of
the affected/diseased breast. Information regarding this policy can be found on www.lamedicaid.com under the Provider Manuals link within
the Professional Services Manual. The Managed Care Organizations will cover services listed on the Louisiana Medicaid Professional
Services and related fee schedules . The fee schedules are updated to reflect additional services. The Managed Care Organizations will be responsible for coverage of the above services for dates of service February 1, 2017 and forward.  Updates to Managed Care Organization changes are plan specific and are the responsibility of each health plan to make appropriate changes to their fee schedule, coverage criteria and
prior authorization process.