Restricted Breast Cancer Surgery Facilities for Medicaid Recipients

Date Issued: 7/5/2018

It is the New York State Department of Health (NYSDOH) policy that Medicaid recipients receive breast cancer surgery at high volume facilities. A high-volume facility is one that performs 30 or more mastectomy and lumpectomy procedures in three years.

Go to the NYSDOH website to see a list of low-volume facilities. Prior authorization requests and claims for mastectomies and lumpectomies submitted by these low volume facilities will be denied.


Last Updated: 06/29/18
JP42163