Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients

Date Issued: 7/14/2026

It is the policy of the New York State Department of Health (NYSDOH) that Medicaid/HARP members receive breast cancer surgery at high-volume facilities. Research shows that five-year survival rates are higher for patients who have breast cancer surgery performed at high-volume facilities. A high-volume facility is one that performs 30 or more mastectomy and lumpectomy procedures annually over a three-year period. 

The NYSDOH annually reviews the surgical volumes of all hospitals and ambulatory surgical centers and releases an updated list of low-volume facilities.  You can see a list of hospital and ambulatory surgery centers on the NYSDOH website where Medicaid will not pay for breast cancer surgery (effective April 1, 2026). 

The policy does not restrict a facility's ability to provide diagnostic or excisional biopsies and post-surgical care (chemotherapy, radiation, reconstruction, etc.).

Preauthorization requests and claims for mastectomies and lumpectomies submitted by these low-volume facilities will be denied. For mastectomy and lumpectomy procedures related to breast cancer, Medicaid/HARP members should be directed to high-volume providers in their area.  Any payments issued by EmblemHealth may be subject to recoupment.

JP71184 7/26