Staged procedures may be covered by Medicaid where shown to be medically necessary.

Topic: Medicaid Eligibility, Decided by Judge Malihi 
Docket Number: 1737794 , Decision Date: 2017-08-25 
Attachment: Click here to download the decision. 

DCH erred by denying prior Medicaid authorization for a bilateral nipple/areola reconstruction and nipple tattooing procedure incident to bilateral breast reduction surgery, the fact that both procedures were not performed simultaneously notwithstanding, where the surgeon seeking Medicaid coverage for the procedure proved, through his own testimony, that the procedure was medically necessary.


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