MedicaidPrior AuthMedium impact
Reconstructive Breast Surgery
Missouri Medicaid (MO HealthNet)·MO · Plastic Surgery, Oncology, General Surgery·Provider Notice
Effective date
Sep 29, 2014
We identified it
Jun 20, 2026
Summary
MO HealthNet now covers reconstructive breast surgery when medically necessary to restore symmetry after mastectomy or other documented medical necessity, but requires prior authorization approval before rendering services. Surgery performed solely for cosmetic purposes remains non-covered.
Action Required
Immediately: Billing team must ensure Prior Authorization Request forms are submitted and approved before scheduling any reconstructive breast surgery for MO HealthNet patients. Update scheduling workflows to verify prior auth status. Claims will be denied without proper authorization.