Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients

01/02/2020

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 hospital and ambulatory surgery centers where Medicaid will not pay for breast cancer surgery.

Preauthorization requests and claims for mastectomies and lumpectomies submitted by these low volume facilities will be denied.


Last Updated: 08/11/20
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