An adjunctive service was performed. The liposuction procedure to harvest the fat is not separately reported. Code used to identify instances where a procedure could be priced under multiple methodologies. A breast prosthesis, silicone or equal, with integrated adhesive is considered not medically necessary because it has not been demonstrated to have a clinical advantage over those without the integrated adhesive.
However, this careful attention to the harvesting and processing of the fat increases operating times. A service or procedure was provided more than once. Surgeries can average more than 1 hour and some can take up to 6 hours, increasing both the risk to the patient and the expense to the facility.
The AMA owns the copyright on the CPT codes and descriptions; CPT codes and descriptions are not public property and must always be used in compliance with copyright law. These are 5 position alpha- numeric codes representing primarily items and nonphysician services that are not represented in the level I codes.
Not long ago, placing fat grafts into the breast was not considered safe. Modifiers may be used to indicate to the recipient of a report that: A custom fabricated prosthesis is one which is individually made for a specific patient starting with basic materials.
New to Outpatient Surgery Magazine? Yes Autologous fat transfer Although most breast reconstructions are performed with implants, some patients are opting for autologous fat transfer AFT procedures.
Some Aetna plans limit coverage to an initial prosthesis and do not cover replacement prostheses. A Adhesive skin support attachment for use with external breast prosthesis, each L Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type L Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type L Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type L Short Description Mastectomy form Short descriptive text of procedure or modifier code 28 characters or less.
Number identifying statute reference for coverage or noncoverage of procedure or service. Fat necrosis was common, and that complication could interfere with subsequent mammograms. Some Aetna plans limit prosthetic coverage to an initial medically necessary prosthesis and do not cover replacement prostheses.
Under both the ASC and OPPS payment systems, a multiple procedure reduction applies, which means the procedure on the contralateral breast is reduced for bilateral procedures performed on the same date of service. A service or procedure has been increased or reduced. The fat is centrifuged and placed into syringes, which are used to transfer the fat into the breast.
These are 5 position alpha-numeric codes comprising the d series. One replacement silicone breast prostheses is considered medically necessary every 24 months.
The codes are divided into two levels, or groups, as described Below: During the procedure, liposuction is performed to harvest fat for the breast reconstruction. For fabric, foam, or fiber-filled breast prostheses, replacements are considered medically necessary every 6 months. A bilateral procedure was performed.
Code used to identify the appropriate methodology for developing unique pricing amounts under part B. They may be constructed of any material e.
Please check benefit plan descriptions for details. Previous Next A modifier provides the means by which the reporting physician or provider can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
These do not include an integrated breast prosthesis. A code denoting Medicare coverage status. Only part of a service was performed.
A procedure may have one to four pricing codes. Aetna considers an external breast prosthesis garment with mastectomy form medically necessary for use in the post-operative period prior to a permanent breast prosthesis or as an alternative to a mastectomy bra and breast prosthesis.
These are 5 position numeric codes representing physician and nonphysician services."Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type" describes a bra with pockets that are intended to hold a mastectomy form or breast prosthesis held adjacent to the chest wall.
HCPCS Code: L The Healthcare Common Prodecure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs.
Breast implant status Billable/Specific Code POA Exempt Z is a billable/specific ICDCM code that can be used to indicate a diagnosis for reimbursement purposes. The HCPCS codes range Breast Prosthetics and Accessories LL is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims.
L - Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type The above description is abbreviated.
This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. Breast surgery can be a challenge to code. Some payers, for example, won't cover reconstructive procedures on prior breast augmentations, while others will cover the reconstructive procedures, but not the implant replacement.Download