Does TRICARE cover breast reduction?

Direct answer: TRICARE covers breast reduction (reduction mammoplasty) when documentation supports medical symptoms, such as backache, upper back and neck pain, shoulder grooving, poor posture, or an inability to take part in normal physical activity because of breast size.

Applies to: All TRICARE plans · All regions

Details

What TRICARE says

TRICARE’s page on reduction mammoplasty says the procedure is covered “when documentation supports the presence of medical symptoms.” The symptoms it lists are:

• backache
• upper back and neck pain
• shoulder grooving
• poor posture
• inability to participate in normal physical activity due to breast size

TRICARE adds that photo documentation may be requested to determine necessity.

What the page does not say

TRICARE’s page does not state whether a referral or pre-authorization is required, and it gives no size or weight thresholds or costs. TRICARE also notes in general that some services have special rules or limits and some are excluded. Because the rules for your plan can differ, ask your regional contractor whether pre-authorization is needed before you schedule surgery.

Cosmetic surgery

TRICARE generally does not cover surgery done only to change appearance; see cosmetic surgery. For how coverage is decided, see TRICARE’s steps for how a benefit becomes covered and how TRICARE handles surgery. The official page is Reduction Mammoplasty.

What to do next

Confirm this with your Primary Care Manager or regional contractor before scheduling — rules can vary by region and by service.