OR SB1137

Health benefit plans in Oregon that cover breast reconstruction services must cover autologous breast reconstruction procedures (using patient's own tissue) and all related medically necessary inpatient and outpatient services, including revisions, when prescribed according to accepted standards of care

Covered procedures include 15 specific flap techniques such as DIEP, SIEA, and gluteal artery perforator flaps, as well as hybrid procedures combining autologous reconstruction with implants

Revision procedures covered include liposuction, grafting, nipple reconstruction, nipple and areola tattoos, fat necrosis excision, capsulotomy, and breast capsulorrhaphy

Carriers must maintain adequate provider networks for these services; if network is insufficient, out-of-network providers must be reimbursed at rates no less than average in-network rates with no additional cost-sharing for patients

Applies to health benefit plans issued, renewed, or extended on or after January 1, 2026