BREAST RECONSTRUCTION POST MASTECTOMY
|
|
- Bathsheba Singleton
- 8 years ago
- Views:
Transcription
1 BREAST RECONSTRUCTION POST MASTECTOMY CLINICAL POLICY Policy Number: SURGERY T2 Effective Date: January 1, 2016 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE... DEFINITIONS... APPLICABLE CODES... BACKGROUND... REFERENCES... POLICY HISTORY/REVISION INFORMATION... Page Related Policies: Refer to the Background section below for a list of related policies The services described in Oxford policies are subject to the terms, conditions and limitations of the Member's contract or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage enrollees. Oxford reserves the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures or applicable state law. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. Certain policies may not be applicable to Self-Funded Members and certain insured products. Refer to the Member's plan of benefits or Certificate of Coverage to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the Member s plan of benefits or Certificate of Coverage, the plan of benefits or Certificate of Coverage will govern. CONDITIONS OF COVERAGE Applicable Lines of Business/Products Benefit Type Referral Required (Does not apply to non-gatekeeper products) Authorization Required (Precertification always required for inpatient admission) Precertification with Medical Director Review Required Applicable Site(s) of Service (If site of service is not listed, Medical Director review is required) Special Considerations This policy applies to Oxford Commercial plan membership General benefits package No Yes 1,2 Yes 1 Inpatient, Office, Outpatient 1 Medical Director review is not required for reconstructive procedures following a mastectomy for cancer (or 1
2 Special Considerations (continued) prophylaxis) 2 Precertification is required for services covered under the Member's General Benefits package when performed in the office of a participating provider. For Commercial plans, precertification is not required, but is encouraged for out-ofnetwork services performed in the office that are covered under the Member's General Benefits package. If precertification is not obtained, Oxford may review for medical necessity after the service is rendered. BENEFIT CONSIDERATIONS Before using this guideline, please check the Member specific benefit document and any federal or state mandates, if applicable. Essential Health Benefits for Individual and Small Group: For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits ( EHBs ). Large group plans (both self-funded and fully insured), and small group ASO plans, are not subject to the requirement to offer coverage for EHBs. However, if such plans choose to provide coverage for benefits which are deemed EHBs (such as maternity benefits), the ACA requires all dollar limits on those benefits to be removed on all Grandfathered and Non-Grandfathered plans. The determination of which benefits constitute EHBs is made on a state by state basis. As such, when using this guideline, it is important to refer to the member specific benefit document to determine benefit coverage. COVERAGE RATIONALE Indications for Coverage Breast reconstruction is covered for Members who have a mastectomy with or without a diagnosis of cancer. Mastectomy includes partial (lumpectomy, tylectomy, quadrantectomy, and segmentectomy), simple, and radical. This benefit does not include aspirations, biopsy (open or core), excision of cysts, fibroadenomas or other benign or malignant tumors, aberrant tissue, duct lesions, nipple or areolar lesions, or treatment of gynecomastia. There is not a time frame in which the Member is required to have the reconstruction done post mastectomy under the Women s Health and Cancer Rights Act of In accordance with Federal and State mandates the following services are covered: Reconstruction of the on which the mastectomy was performed Surgery and reconstruction of the other to produce a symmetrical appearance, including nipple tattooing Prosthesis (Implanted and/or external) Treatment of physical complications of mastectomy, including lymphedema Various surgical techniques are used for reconstruction, including but not limited to: Insertion of FDA approved implants and tissue expanders Breast Implants and tissue expanders post mastectomy with or without skin substitutes, approved by the FDA, including but not limited to: Alloderm, Allomax or FlexHD are a covered benefit Transverse Rectus Abdominus Myocutaneous Flap (TRAM) Latissimus Dorsi Flap (LD) Deep Inferior Epigastric Perforator (DIEP) Flap 2
3 Gluteal Flap (GAP free flap) Refer to the Definitions section for reconstruction procedure definitions. If the original implant or reconstructive surgery was considered reconstructive surgery by Oxford, coverage may exist for removal, replacement and/or reconstruction. If the original implant or reconstructive surgery was considered reconstructive surgery under the Oxford benefit document, then removal of a ruptured prosthesis is treating a "complication arising from a medical or surgical intervention." Removal or replacement of an implant that is not ruptured and unassociated with local complications may not be covered. Additional Information: An in-network exception may be granted if there is not an in-network provider able to provide the requested reconstructive procedure. Refer to the Member specific benefit document and the In- Network Exceptions for Breast Reconstruction Surgery Following Mastectomy policy for information regarding coverage from non-network providers. Breast reconstruction may be covered under certain circumstances for the surgical treatment of gender dysphoria. Please refer to the member s specific benefit document for coverage determination. Treatments for complications post mastectomy 1. Lymphedema: a. Complex Decongestive Physiotherapy (CDP) is covered for the complication of lymphedema post mastectomy b. Lymphedema pumps when required are covered c. Compression Lymphedema sleeves are covered d. Elastic bandages and wraps associated with covered treatments for the complications of lymphedema 2. Treatment of a post operative infection(s). 3. Removal of a ruptured implant (either silicone or saline) is reconstructive for implants done post mastectomy. Placement of a new implant will be covered if the original implantation was done post mastectomy or for a covered reconstructive health service. Coverage Limitations and Exclusions Please refer to Member s state mandates and Member specific benefit documents. 1. Insertion of implants or reinsertion of implants for the purpose of improving appearance is a cosmetic procedure unless covered under a state or federal mandate. Note: If the reconstruction has been successfully completed post mastectomy and the Member chooses to enlarge their s for cosmetic reasons, this is considered a cosmetic service and is not covered. 2. Breast reconstruction or scar revision after biopsy or removal of a cyst with or without a biopsy usually does not meet the definition of a covered reconstructive health service. Refer to the Member s specific benefit documents and state mandates. 3. Tissue protruding at the end of a scar ( dog ear /standing cone), painful scars or donor site scar revisions must be reviewed to determine if the procedure meets reconstructive guidelines. 4. Liposuction other than to achieve symmetry during post mastectomy reconstruction is considered cosmetic and is not covered. 5. Revision of prior reconstructed due to normal aging does not meet the definition of a covered reconstructive health service. 6. Not medically necessary services. 3
4 DEFINTIONS Breast Reconstruction Steps: STEP 1: Creation of a mound: Reposition a woman s own muscle, fat and skin to create a mound. TRAM Flap - the muscle, fat and skin from the lower abdomen is used to reconstruct the. DIEP or SGAP Flap the fat and skin but not muscle is used from the lower abdomen or buttocks to reconstruct the. LATISSIUMS DORSI Flap the muscle, fat and skin from the back are used to reconstruct the may also need a implant. Tissue expansion is used to stretch the skin to provide coverage for a implant to create a mound. Requires several office visits over 4-6 months to fill the device through an internal valve to expand the skin. A second surgical procedure is needed to replace the expander. Surgical placement of a implant creates a mound. May be used with a flap or alone following tissue expansion. Silicone and saline implants are available for reconstruction. Reconstruction alone may be done with an implant but usually as tissue expander is needed. STEP 2: Creation of a nipple and areola: Many different techniques are used. Tattooing may be used for the areola. Deep Inferior Epigastric Perforator (DIEP) Flap: The DIEP flap technique uses abdominal skin and subcutaneous tissue while sparing the rectus abdominus muscle. Blood vessels, called deep inferior epigastric perforators (DIEP), with the overlying skin and fat supplied by them, are removed from the lower abdomen and transferred to the chest to reconstruct a after mastectomy. Gluteal Artery Perforator (GAP) Free Flap: Superior Gluteal Artery Perforator (S-GAP) Flap: The superior gluteal artery perforator flap involves microsurgical transfer of skin and fat from the buttock without muscle sacrifice. The flap is vascularized by one single perforator originating from the superior gluteal artery. Inferior Gluteal Artery Perforator (I-GAP) Free Flap: The IGAP is harvested using the same microsurgical, muscle-sparing techniques as the DIEP and S-GAP flaps. Latissimus Dorsi Flap (LD): The LD flap moves muscle (and skin if required) from the back to reconstruct the. It may be transferred as a free tissue transfer or rotated into place as a pedicle flap to reconstruct the. Mastectomy: Mastectomy includes partial (lumpectomy, tylectomy, quadrantectomy, and segmentectomy), simple, and radical. A mastectomy does not include aspirations, biopsy (open or core), excision of cysts, fibroadenomas or other benign or malignant tumors, aberrant tissue, duct lesions, nipple or areolar lesions, and treatment of gynecomastia. "Stacked" DIEP Flap: This procedure allows for incorporation of more abdominal fatty tissue than conventional TRAM procedures or unilateral DIEP flap procedures. 4
5 Superficial Inferior Epigastric Artery (SIEA) Flap: Replaces the skin and soft tissue removed at mastectomy with skin and fatty tissue harvested from the abdomen. Transverse Rectus Abdominus Myocutaneous (TRAM) Flap: The surgeon takes muscle and overlying lower abdominal tissue and moves it to the chest area. TRAM flap may be done as either a pedicle flap or a free flap. Women's Health and Cancer Rights Act of 1998, 713 (a): "In general - a group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall provide, in case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects reconstruction in connection with such mastectomy, coverage for (1) reconstruction of the on which the mastectomy has been performed; (2) surgery and reconstruction of the other to produce symmetrical appearance; and (3) prostheses and physical complications all stages of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient." APPLICABLE CODES The Current Procedural Terminology (CPT ) codes and Healthcare Common Procedure Coding System (HCPCS) codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the member specific benefit document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claims payment. Other policies and coverage determination guidelines may apply. This list of codes may not be all inclusive. Mastectomy CPT Codes CPT Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy Mastectomy, simple, complete Mastectomy, subcutaneous Mastectomy, radical, including pectoral muscles, axillary lymph nodes Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle CPT is a registered trademark of the American Medical Association. The following CPT codes do not meet criteria for post mastectomy (do not apply to reconstruction). CPT Code Biopsy of ; percutaneous, needle core, not using imaging guidance (separate procedure) Biopsy of ; open, incisional Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, one or more lesions Excision of lesion identified by preoperative placement of radiological marker, open; single lesion Excision of lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to 5
6 CPT Code code for primary procedure) Excision tumor, soft tissue of neck or thorax; subcutaneous Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular Breast Reconstruction Post Mastectomy CPT Codes CPT Code Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Replacement of tissue expander with permanent prosthesis Removal of tissue expander(s) without insertion of prosthesis Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie,, trunk) (List separately in addition to code for primary procedure) Mastopexy Mammaplasty, augmentation; without prosthetic implant Mammaplasty, augmentation; with prosthetic implant Immediate insertion of prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Breast reconstruction with latissimus dorsi flap, without prosthetic implant Breast reconstruction with free flap Breast reconstruction with other technique Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site; with microvascular anastomosis (supercharging) Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site Revision of reconstructed Preparation of moulage for custom implant Unlisted procedure, The code below is covered only to achieve symmetry of the contralateral post mastectomy 6
7 CPT Code Reduction mammoplasty CPT is a registered trademark of the American Medical Association. Applicable HCPCS Code HCPCS Code L8600* Implantable prosthesis, silicone or equal *Refer to policies: Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/Replacements Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs Applicable ICD-9 Codes (Discontinued 10/01/15) The following list of codes is provided for reference purposes only. Effective October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) implemented ICD-10-CM (diagnoses) and ICD- 10-PCS (inpatient procedures), replacing the ICD-9-CM diagnosis and procedure code sets. ICD-9 codes will not be accepted for services provided on or after October 1, ICD-9 Procedure Code (Discontinued 10/01/15) Malignant neoplasm of nipple and areola of female Malignant neoplasm of central portion of female Malignant neoplasm of upper-inner quadrant of female Malignant neoplasm of lower-inner quadrant of female Malignant neoplasm of upper-outer quadrant of female Malignant neoplasm of lower-outer quadrant of female Malignant neoplasm of axillary tail of female Malignant neoplasm of other specified sites of female Malignant neoplasm of (female), unspecified site Malignant neoplasm of nipple and areola of male Secondary malignant neoplasm of Carcinoma in situ of V10.3 Personal history of malignant neoplasm of V45.71 Acquired absence of and nipple V51.0 Encounter for reconstruction following mastectomy ICD-10 Codes ICD-10-CM (diagnoses) and ICD-10-PCS (inpatient procedures) must be used to report services provided on or after October 1, ICD-10 codes will not be accepted for services provided prior to October 1, 2015 ICD-10 Diagnosis Code C Malignant neoplasm of nipple and areola, right female C Malignant neoplasm of nipple and areola, left female C Malignant neoplasm of nipple and areola, unspecified female C Malignant neoplasm of nipple and areola, right male C Malignant neoplasm of nipple and areola, left male C Malignant neoplasm of nipple and areola, unspecified male C Malignant neoplasm of central portion of right female C Malignant neoplasm of central portion of left female C Malignant neoplasm of central portion of unspecified female C Malignant neoplasm of central portion of right male C Malignant neoplasm of central portion of left male C Malignant neoplasm of central portion of unspecified male 7
8 ICD-10 Diagnosis Code C Malignant neoplasm of upper-inner quadrant of right female C Malignant neoplasm of upper-inner quadrant of left female C Malignant neoplasm of upper-inner quadrant of unspecified female C Malignant neoplasm of upper-inner quadrant of right male C Malignant neoplasm of upper-inner quadrant of left male C Malignant neoplasm of upper-inner quadrant of unspecified male C Malignant neoplasm of lower-inner quadrant of right female C Malignant neoplasm of lower-inner quadrant of left female C Malignant neoplasm of lower-inner quadrant of unspecified female C Malignant neoplasm of lower-inner quadrant of right male C Malignant neoplasm of lower-inner quadrant of left male C Malignant neoplasm of lower-inner quadrant of unspecified male C Malignant neoplasm of upper-outer quadrant of right female C Malignant neoplasm of upper-outer quadrant of left female C Malignant neoplasm of upper-outer quadrant of unspecified female C Malignant neoplasm of upper-outer quadrant of right male C Malignant neoplasm of upper-outer quadrant of left male C Malignant neoplasm of upper-outer quadrant of unspecified male C Malignant neoplasm of lower-outer quadrant of right female C Malignant neoplasm of lower-outer quadrant of left female C Malignant neoplasm of lower-outer quadrant of unspecified female C Malignant neoplasm of lower-outer quadrant of right male C Malignant neoplasm of lower-outer quadrant of left male C Malignant neoplasm of lower-outer quadrant of unspecified male C Malignant neoplasm of axillary tail of right female C Malignant neoplasm of axillary tail of left female C Malignant neoplasm of axillary tail of unspecified female C Malignant neoplasm of axillary tail of right male C Malignant neoplasm of axillary tail of left male C Malignant neoplasm of axillary tail of unspecified male C Malignant neoplasm of overlapping sites of right female C Malignant neoplasm of overlapping sites of left female C Malignant neoplasm of overlapping sites of unspecified female C Malignant neoplasm of overlapping sites of right male C Malignant neoplasm of overlapping sites of left male C Malignant neoplasm of overlapping sites of unspecified male C Malignant neoplasm of unspecified site of right female C Malignant neoplasm of unspecified site of left female C Malignant neoplasm of unspecified site of unspecified female C Malignant neoplasm of unspecified site of right male C Malignant neoplasm of unspecified site of left male C Malignant neoplasm of unspecified site of unspecified male C79.81 Secondary malignant neoplasm of D05.00 Lobular carcinoma in situ of unspecified D05.01 Lobular carcinoma in situ of right D05.02 Lobular carcinoma in situ of left 8
9 ICD-10 Diagnosis Code D05.10 Intraductal carcinoma in situ of unspecified D05.11 Intraductal carcinoma in situ of right D05.12 Intraductal carcinoma in situ of left D05.80 Other specified type of carcinoma in situ of unspecified D05.81 Other specified type of carcinoma in situ of right D05.82 Other specified type of carcinoma in situ of left D05.90 Unspecified type of carcinoma in situ of unspecified D05.91 Unspecified type of carcinoma in situ of right D05.92 Unspecified type of carcinoma in situ of left Z42.1 Encounter for reconstruction following mastectomy Z85.3 Personal history of malignant neoplasm of Z90.10 Acquired absence of unspecified and nipple Z90.11 Acquired absence of right and nipple Z90.12 Acquired absence of left and nipple Z90.13 Acquired absence of bilateral s and nipples BACKGROUND Breast reconstruction is the rebuilding of a. It involves using autologous tissue or prosthetic material to construct a natural-looking. Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or relocated flaps of the patient's own tissue. Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a to near normal shape, appearance and size. This policy addresses reconstructive procedures following a mastectomy and treatments of complications post mastectomy. For information regarding repair/reconstruction not following a mastectomy, refer to the policy titled Breast Repair/ Reconstruction (Not Following Mastectomy). For additional information, please refer to the following related policies: In-Network Exceptions for Breast Reconstruction Surgery Following Mastectomy Breast Repair/ Reconstruction (Not Following Mastectomy) Cosmetic and Reconstructive Procedures Breast Reduction Surgery Gynecomastia Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/Replacements Pneumatic Compression Devices Prosthetic Devices, Wigs, Specialized, Microprocessor or Myoelectric Limbs Gender Dysphoria (Gender Identity Disorder) Treatment REFERENCES The foregoing Oxford policy has been adapted from an existing UnitedHealthcare national policy that was researched, developed and approved by UnitedHealthcare Coverage Determination Committee. [CDG , Effective 01/01/2016] 1. American Society of Plastic Surgeons. Breast Reconstruction Procedures Steps. Available at: Accessed on September 3, Federal Mandate: The Women's Health and Cancer Rights Act of (Reconstructive Breast Surgery). September 9, 2002, Revision Date July 16,
10 POLICY HISTORY/REVISION INFORMATION Date 01/01/2016 Action/ Revised conditions of coverage/special considerations; added language to indicate: o Precertification is required for services covered under the Member's General Benefits package when performed in the office of a participating provider o For Commercial plans, precertification is not required, but is encouraged for out-of-network services performed in the office that are covered under the Member's General Benefits package; if precertification is not obtained, Oxford may review for medical necessity after the service is rendered Revised coverage rationale/indications for coverage; o Updated list of services covered in accordance with federal/state mandate; replaced prosthesis (implanted or external) with prosthesis (Implanted and/or external) o Added language to indicate reconstruction may be covered under certain circumstances for the surgical treatment of gender dysphoria (refer to the enrollee specific benefit document for coverage determination) Updated supporting information to reflect the most current background information and references Archived previous policy version SURGERY T2 10
BREAST RECONSTRUCTION POST MASTECTOMY
COVERAGE DETERMINATION GUIDELINE BREAST RECONSTRUCTION POST MASTECTOMY Guideline Number: CDG.003.05 Effective Date: January 1, 2016 Table of Contents COVERAGE RATIONALE... DEFINITIONS... APPLICABLE CODES...
More informationMedical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8
Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan
More informationBreast Reconstruction Surgery
Breast Reconstruction Surgery I. Policy University Health Alliance (UHA) will reimburse for Breast Reconstruction Surgery when it is determined to be medically necessary and when it meets the medical criteria
More informationBreast Implants and Reconstruction
Last Review Date: October 9, 2015 Number: MG.MM.SU.fv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationBreast Reconstruction Following Mastectomy or Lumpectomy
Breast Reconstruction Following Mastectomy or Lumpectomy [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click Cartas
More informationMedical Policy Reconstructive Breast Surgery/Management of Breast Implants
Medical Policy Reconstructive Breast Surgery/Management of Breast Implants Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References
More informationNote: For information related to the medical necessity criteria for mammaplasty procedures, see SURG.00086 Reduction Mammaplasty.
Subject: Document#: Current Effective Date: 10/01/2008 Status: Revised Last Review Date: 08/28/2008 Description/Scope Reconstructive breast surgery refers to surgical procedures to rebuild the contour
More informationBreast Reconstruction Frequently Asked Questions
Breast Reconstruction Frequently Asked Questions GENERAL Do I need to have breast reconstruction? It is never medically necessary to have breast reconstruction. This is considered an elective procedure,
More informationBreast Reconstruction. What You Should Know
Breast Reconstruction What You Should Know M astectomy for treating breast cancer is the most common reason that women have breast reconstruction. In fact, the number of women undergoing this reconstructive
More informationSUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE:
MEDICAL POLICY SUBJECT: MANAGEMENT OF BREAST PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy
More informationBREAST RECONSTRUCTIVE SURGERY
BREAST RECONSTRUCTIVE SURGERY Policy Number: 2013M0043A Effective Date: January 1, 2014 Table of Contents: Page: Cross Reference Policy: POLICY DESCRIPTION 2 Bioengineered Skin Substitutes, COVERAGE RATIONALE/CLINICAL
More informationICD-10 Diagnostic Coding for. Breast Reconstruction
ICD-10 Diagnostic Coding for Webinar Hosted by: Breast Reconstruction December 5, 2013 Presented by: Kim Pollock, RN, MBA, CPC Meet Kim Pollock RN, MBA, CPC Kim Pollock, RN, MBA, CPCspecializes in streamlining
More informationChapter 24. Evolution of Procedures
Chapter 24 BREAST SURGERY KEY FIGURES: Saline implant reconstruction Latissimus dorsi reconstruction Free TRAM reconstruction In the developed world, breast reconstruction after mastectomy and breast reduction
More informationDr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery.
Dr. Hans R. Kuisle, M.D., F.A.C.S Dr. Winfield Hartley, M.D., F.A.C.S Dr. Justin B. Maxhimer, M.D. 2525 4 th Street, Suite 200, Boulder, CO 80304 Boulder Plastic Surgery: 303-443-2277 IV Seasons Skin Care:
More informationReshaping You. Breast Reconstruction for Breast Cancer Patients
Reshaping You Breast Reconstruction for Breast Cancer Patients Foreword Women diagnosed with breast cancer begin a journey that requires making health care decisions that can have profound effects on their
More informationCorporate Medical Policy Breast Surgeries
Corporate Medical Policy Breast Surgeries File Name: Origination: Last CAP Review: Next CAP Review: Last Review: breast_surgeries 1/2000 9/2015 9/2016 9/2015 Description of Procedure or Service Policy
More informationMEDICAL POLICY No. 91545-R7 BREAST RELATED PROCEDURES*
BREAST RELATED PROCEDURES* Effective Date: December 17, 2015 Review Dates: 8/07, 8/08, 8/09, 4/10, 6/10, 8/10, 8/11, 8/12, 6/13, 8/14, 8/15 Date of Origin: August 8, 2007 Status: Current *This policy includes
More informationPANNICULECTOMY & BODY CONTOURING PROCEDURES
COVERAGE DETERMINATION GUIDELINE PANNICULECTOMY & BODY CONTOURING PROCEDURES Guideline Number: CDG.014.05 Effective Date: December 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE
More informationBreast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus
Breast Reconstruction Options Department of Plastic Surgery #290 Santa Clara Homestead Campus Importance of Breast Reconstruction As successes in treating breast cancer have grown, more women have been
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): 6/21/2004 Most Recent Review Date (Revised): 3/24/2015 Effective Date: 12/31/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS
More informationRotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma
Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History
More informationINPATIENT CONSULTATIONS
INPATIENT CONSULTATIONS REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 228.7 T0 Effective Date: February, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
More informationOBSERVATION CARE EVALUATION AND MANAGEMENT CODES
REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationAccelerated Partial Breast Irradiation (APBI) for Breast Cancer
Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click
More informationCMS Limitations Guide Mammograms and Bone Density Radiology Services
CMS Limitations Guide Mammograms and Bone Density Radiology Services Starting July 1, 2008, CMS has placed numerous medical necessity limits on tests and procedures. This reference guide provides you with
More informationIntegumentary System Individual Exercises
Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this
More informationBenefits Collaborative Policy Statement WOMEN S HEALTH SERVICES
Page 1 uf 5 The services listed below are not inclusive of all services available to women on Medicaid, but WOMEN S HEALTH SERVICES Benefits Collaborative Policy Statement Women s health services are preventative
More informationAccelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required]
Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: February 24, 2012 Revised:
More informationTHE DECISION GUIDE TO BREAST RECONSTRUCTION
THE DECISION GUIDE TO BREAST RECONSTRUCTION Breast reconstruction is the process of making a new breast after mastectomy (removal of the breast) for breast cancer treatment or prevention ( therapeutic
More informationAccelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required]
Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: Revised: This policy applies
More informationSurgery Choices. National Cancer Institute. For Women with DCIS or Breast Cancer. National Institutes of Health
National Cancer Institute Surgery Choices For Women with DCIS or Breast Cancer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health The National Cancer Institute is grateful for our
More informationWhat You Need to Know About Breast Reconstruction Surgery
Millard Fillmore Suburban Hospital A Kaleida Health Facility What You Need to Know About Breast Reconstruction Surgery This packet of information contains choices that are available to you regarding breast
More informationIf you have questions about DCIS, call the Cancer Prevention and Treatment Fund s DCIS hotline at 202-223-4000 or write us at info@stopcancerfund.
This free booklet was developed and produced by the Cancer Prevention and Treatment Fund CFC # 11967 If you have questions about DCIS, call the Cancer Prevention and Treatment Fund s DCIS hotline at 202-223-4000
More informationNational Mastectomy and Breast Reconstruction Audit. Prospective Audit Dataset. Final Version
National Mastectomy and Breast Reconstruction Audit Prospective Audit Final Version 1 Purpose This document contains the technical specification of the proposed dataset for the prospective audit phase
More informationBreast Reconstruction Surgery
Breast Reconstruction Surgery Breast Cancer Centre of Hope Breast Cancer Navigator 204-788-8080 Toll-free in Manitoba1-888-660-4866 Types of mastectomies Steps of breast reconstruction Breast reconstruction
More informationAutologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation
ASERNIP S Australian Safety and Efficacy Register of New Interventional Procedures-Surgical Systematic Review Autologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation September 2010
More informationLinks in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.
Local Coverage Determination (LCD): Plastic Surgery (L35163) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name
More informationBreast Reconstruction After Mastectomy
Breast Reconstruction After Mastectomy Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast mound to match the size and shape
More informationPROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL
Oncoplastic breast conservation surgery Melvin J Silverstein C H A P T E R 5 Introduction Oncoplastic breast conservation surgery combines oncologic principles with plastic surgical techniques. But it
More informationNational Medical Policy
National Medical Policy Subject: Policy Number: Breast Reconstructive Surgery NMP492 Effective Date*: February 2013 Updated: April 2015 This National Medical Policy is subject to the terms in the IMPORTANT
More informationPolicy #: 111 Latest Review Date: January 2010
Name of Policy: Co-surgeons and Team Surgeons Policy #: 111 Latest Review Date: January 2010 Category: Administrative Policy Grade: N/A Background: As a general rule, benefits are payable under Blue Cross
More informationLesions, and Masses, and Tumors Oh My!!
Lesions, and Masses, and Tumors Oh My!! Presented by: Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT DEFINITIONS OP REPORT CASES 2 Definitions Cyst - a closed sac having
More informationOncoplastic breast surgery e A guide to good practice
EJSO 33 (2007) S1eS23 www.ejso.com Oncoplastic breast surgery e A guide to good practice On behalf of the Association of Breast Surgery at BASO, BAPRAS and the Training Interface Group in Breast Surgery*
More informationFRIEND TO FRIEND CPT CODES 2015 2016. Diagnostic digital breast tomosynthesis, unilateral (list separately in addition to code for primary procedure)
FRIEND TO FRIEND CPT CODES 2015 2016 CPT CODE SERVICE DESCRIPTION FEE EFFECTIVE G0101 Screening pelvic examination $36.69 01 Jan 16 G0202 Mammography, screening, digital, bilateral (2 view film study of
More informationMedical Necessity Guidelines: Reconstructive and Cosmetic Surgery
Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: October 1, 2015 Clinical Documentation and Prior Authorization Required Coverage Guideline, No Prior Authorization Applies to:
More informationICD-10 and General Surgery
ICD-10 and General Surgery Steven M. Verno CMBS, CEMCS, CMSCS, CPM-MCS Page 1 of 25 ICD-10 and General Surgery Steven M. Verno Revised January 13, 2014 Note: ICD-9-CM and ICD-10 are owned and copyrighted
More informationClinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center
Printed Name Clinical Privileges Profile Plastic Surgery Indu & Raj Soin Medical Center Applicant: Check off the Requested box for each privilege requested. Applicants have the burden of producing information
More informationBreast Reconstructive Surgery BREAST RECONSTRUCTIVE SURGERY HS-280. Policy Number: HS-280. Original Effective Date: 2/5/2015. Revised Date(s): N/A
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationName of Policy: Reconstructive versus Cosmetic Surgery
Name of Policy: Reconstructive versus Cosmetic Surgery Policy #: 106 Latest Review Date: February 2010 Category: Administrative Policy Grade: Background/Definitions: As a general rule, benefits are payable
More informationMEDICAL ASSISTANCE BULLETIN
MEDICAL ASSISTANCE BULLETIN ISSUE DATE October 20, 2008 EFFECTIVE DATE November 3, 2008 NUMBER 99-08-17 SUBJECT BY Implementation of ClaimCheck Michael Nardone, Deputy Secretary Office of Medical Assistance
More informationBreast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D.
Breast Cancer: from bedside and grossing room to diagnoses and beyond Adriana Corben, M.D. About breast anatomy Breasts are special organs that develop in women during puberty when female hormones are
More informationBreast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.
Breast Cancer Introduction Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 out of 8 women are diagnosed with breast
More informationBreast Reconstruction After Mastectomy
Breast Reconstruction After Mastectomy What is breast reconstruction? Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast
More informationBreast Reconstruction
Breast Reconstruction by Editorial Staff and Contributors En Español (Spanish Version) Click here to view an animated version of this procedure. Definition Breast reconstruction is plastic surgery to rebuild
More informationCARE PLAN OVERSIGHT POLICY
REIMBURSEMENT POLICY CARE PLAN OVERSIGHT POLICY Policy Number: ADMINISTRATIVE 7.0 T0 Effective Date: July, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
More informationMedicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests
Mammograms - Updated Billing Guide for Screening and Diagnostic Tests This article from Medicare B News Issue 223 dated October 21, 2005 is being updated and reprinted to ensure that the Noridian Administrative
More informationCancer Surgery Volume Study: ICD-9 and CPT Codes
This paper contains the ICD-9 diagnostic and procedure codes and the CPT procedure codes used by researchers for a project of the California HealthCare Foundation (CHCF) and the California Office of Statewide
More informationQuick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants
Quick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants Important Factors Breast Augmentation Patients Should Consider October 2015 Caution: Federal law restricts this device
More informationIllinois Insurance Facts Illinois Department of Insurance Coverage for the Diagnosis and Treatment of Breast Conditions
Illinois Insurance Facts Illinois Department of Insurance Coverage for the Diagnosis and Treatment of Breast Conditions Revised May 2015 Note: This information was developed to provide consumers with general
More informationAn individual is considered an incident case only once per lifetime.
1 DERM 4 MALIGNANT MELANOMA; SKIN Includes Invasive Malignant Melanoma Only; Does Not Include Secondary Melanoma; For Malignant Melanoma In-Situ, See Corresponding Case Definition Background This case
More informationSAME DAY/SAME SERVICE
SAME DAY/SAME SERVICE REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 7. T0 Effective Date: June, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
More informationCoding Companion for Radiology. A comprehensive illustrated guide to coding and reimbursement
Coding Companion for Radiology A comprehensive illustrated guide to coding and reimbursement 2013 Contents Getting Started with Coding Companion...i Diagnostic Radiology Head/Neck...1 Chest...38 Spine/Pelvis...51
More informationAestheticare Cosmetic Surgery Institute Dr. Ronald E. Moser 30260 Rancho Viejo Rd. San Juan Capistrano, CA 92675 (800) 662-1055
Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics, pregnancy, weight changes, sun exposure,
More informationLocal Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328)
Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID L29328
More informationQ: What differentiates a diagnostic from a screening mammography procedure?
The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure
More informationMEDICAL MANAGEMENT POLICY
TITLE: Scar Revision/Keloid PAGE: 1of 9 This Medical policy is not a guarantee of benefits or coverage, nor should it be deemed as medical advice. In the event of any conflict concerning benefit coverage,
More informationProvider Reimbursement for Women's Cancer Screening Program
Reimbursement Schedule July 1, 2015 June 30, 2016 Office Visits - Established Patients Office Visit / Minimal / no physician 99211 $ 16.70 Office Visit / Problem focused History / exam 99212 $ 36.46 Preventive
More informationFat Injection to Correct Contour Deformities in the Reconstructed Breast
Fat Injection to Correct Contour Deformities in the Reconstructed Breast Scott L. Spear, M.D., Henry B. Wilson, M.D., and Michelle D. Lockwood, M.D. Washington, D.C. Background: A ten-year, single-surgeon
More informationDaman Published Rates
Daman Published Rates Non-Network Services Price List Daman Published Rates as applicable for covered Health Services in Non-Network Providers TABLE OF CONTENTS WELCOME... 3 HOW TO READ THE PRICE LIST?...
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationEarly-stage Breast Cancer Treatment: A Patient and Doctor Dialogue
page 1 Early-stage Breast Cancer Treatment: A Patient and Doctor Dialogue Q: What is breast cancer, and what type do I have? A: Cancer is a disease in which cells become abnormal and form more cells in
More informationBreast Augmentation Amsterdam Plastic Surgery Breast Augmentation Overview
Breast Augmentation Amsterdam Plastic Surgery Breast Augmentation Overview The long-lasting results of breast augmentation are not limited to just physical changes as data documents that many patients
More informationHow To Improve Your Looks with Plastic Surgery
How To Improve Your Looks with Plastic Surgery By Daniel Becker Plastic surgery is a special type of surgery that involves both a person's appearance and his or her ability to function. Plastic surgeons
More informationAPPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE
Appendix DApril 1, 2015 PREAMBLE 1. Surgery to alleviate significant physical symptoms, which have not responded to a minimum of six months active treatment, or to restore or improve function to any area
More informationLocal Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125)
Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125) Contractor Information Contractor Name Palmetto GBA LCD Information Document Information LCD ID L36125 Original ICD-9 LCD
More informationCosmetic Surgery Procedures
Last Review Date: July 20, 2015 Number: MG.MM.AD.07cC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationBreast Cancer and Treatment
PATIENT EDUCATION patienteducation.osumc.edu Breast cancer affects nearly 200,000 women each year in the United States. The risk of developing breast cancer over a lifetime is 1 in 8, or 12%. Breast cancer
More informationCARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION
CLINICAL POLICY CARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION Policy Number: CARDIOLOGY 026.6 T2 Effective Date: May 1, 2015 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE... BENEFIT
More informationCHAPTER 9. Plastic and Reconstructive Surgery of the Breast
CHAPTER 9 Plastic and Reconstructive Surgery of the Breast Augmentation Mammaplasty Silicone Facts Breast Examinations Mastopexy (Breast Lifting) Reduction Mammaplasty Breast Reconstruction Note: Prior
More informationPhysicians as Assistants at Surgery: 2013 Study Participating Organizations:
Physicians as Assistants at Surgery: 2013 Study Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of
More informationLesions, and Masses,
Lesions, and Masses, and dtumors Oh My!! Presented by: Betty Johnson, CPC, CPC-I, CCS-P, PCS, CPC-H, RMC, CCP, CIC, CPCD and Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT
More informationXXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND
STATE OF MICHIGAN DEPARTMENT OF ENERGY, LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE REGULATION Before the Commissioner of Financial and Insurance Regulation In the matter of XXXXX File No.
More informationRotator Cuff Repair Surgical Procedures
Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM
More informationINFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001
INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001 NOTE: The members contract should be reviewed. Contract language may vary regarding the definition of reconstructive services for different
More informationTissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity
Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity Robert Cohen, MD, FACS* Paradise Valley, AZ Case summary A 41-year old woman with a history
More informationBreast Cancer Surgery at the University of Michigan Comprehensive Cancer Center
Breast Cancer Surgery at the University of Michigan Comprehensive Cancer Center Staff of the following programs provided information for this handbook: Comprehensive Cancer Center Breast Care Center Patient
More informationMedicaid Expansion and Change in Hospital Emergency Department Visits for Oral Health Conditions among Rhode Island Adults
Medicaid Expansion and Change in Hospital Emergency Department Visits for Oral Health Conditions among Rhode Island Adults Junhie Oh, BDS, MPH Oral Health Epidemiologist/Evaluator Division of Community,
More informationCOPYRIGHT ASPS. Breast Augmentation. The Symbol of Excellence in Plastic Surgery
Breast Augmentation The Symbol of Excellence in Plastic Surgery A public education service of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. This brochure
More informationPhysicians as Assistants at Surgery: 2016 Update Participating Organizations:
Physicians as Assistants at Surgery: 2016 Update Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of
More informationHelen Joseph Breast Care Clinic - Johannesburg, South Africa
- Johannesburg, South Africa General Information New breast cancer cases treated per year 360 Breast multidisciplinarity team members 12 Radiologists, surgeons, pathologists, medical oncologists, radiotherapists
More informationMichael A. Boss, M.D. FMH Plastic, Reconstructive und Aesthetic Surgery
Michael A. Boss, M.D. FMH Plastic, Reconstructive und Aesthetic Surgery Boss Aesthetic Center Schauplatzgasse 23 CH-3011 Bern Switzerland +41 31 311 7691 www.aesthetic-center.com B r e a s t A u g m e
More informationDeveloped by the Cancer Detection Section California Department of Public Health January, 2010 Cancer Detection Programs: Every Woman Counts
a Woman s Guide to Breast Cancer Treatment Developed by the Cancer Detection Section California Department of Public Health January, 2010 Cancer Detection Programs: Every Woman Counts table of contents
More informationAMBULANCE SERVICES. Page
AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CDG.001.03 Effective Date: June 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE CODES... REFERENCES... HISTORY/REVISION
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENTAL APPEALS BOARD DECISION OF MEDICARE APPEALS COUNCIL
DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENTAL APPEALS BOARD DECISION OF MEDICARE APPEALS COUNCIL In the case of Robert E. Rothfield, M.D. (Appellant) Claim for Supplementary Medical Insurance Benefits
More informationOBSTETRICAL POLICY. Page
OBSTETRICAL POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 200.14 T0 Effective Date: April 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
More informationKYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment
KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer
More informationModifiers 25 and 59. Modifier 25
Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure
More informationBreast Cancer and Early Detection - A Woman's Guide
A WOMAN S GUIDE TO BREAST CANCER DIAGNOSIS AND TREATMENT Developed by the California Department of Health Services Breast Cancer Early Detection Program TABLE OF CONTENTS 1 Introduction... 1 2Breast Biopsy...
More informationWhat You Need to Know Before Treatment About: Breast Cancer
What You Need to Know Before Treatment About: Breast Cancer Publication MDCH-1234 Revised: September 2008 Authority: Public Act 368 of 1978, as amended by Public Act 195 of 1986 and Public Act 15 of 1989.
More informationIt is important that you read this information carefully and completely.
Placement of Permanent Breast Implant Following Tissue Expansion 1. I hereby authorize Dr. John P. Stratis and such assistants as may be selected to perform the following procedure or treatment INFORMED-
More information