Breast Reconstruction Following Mastectomy or Lumpectomy

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Breast Reconstruction Following Mastectomy or Lumpectomy"

Transcription

1 Breast Reconstruction Following Mastectomy or Lumpectomy [For the list of services and procedures that need preauthorization, please refer to Go to Comunicados a Proveedores, and click Cartas Circulares.] Medical Policy: MP-SU Original Effective Date: March 25, 2010 Reviewed: Revised: March 19, 2013 This policy applies to products subscribed by the following corporations, MCS Life Insurance Company (Commercial), and MCS Advantage, Inc. (Classicare) and, provider s contract; unless specific contract limitations, exclusions or exceptions apply. Please refer to the member s benefit certification language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply subject to the aforementioned exceptions. DESCRIPTION For the purposes of this medical policy, reconstructive breast surgery refers to surgery performed to individuals who underwent mastectomy or lumpectomy to correct or repair abnormal structures of the breast. Breast reconstruction is often considered after mastectomy to correct deformity or reestablish symmetry caused by previous surgery and/or the effects of therapeutic treatments. Reconstruction procedures may involve multiple techniques and stages to recreate the breast mound using prosthetic implants, tissue flaps, or autologous tissue transfers, as well as nipple/areola reconstruction or tattooing and breast reduction. These procedures can be performed immediately after a mastectomy (one stage breast reconstruction), or be delayed for weeks or years until a patient undergoes radiation, chemotherapy, or determines whether they want breast reconstruction (two-stage reconstruction). COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate member certificate and subscriber agreement contract for applicable diagnostic imaging, DME, laboratory, machine tests, benefits, and coverage. INDICATIONS Note: Breast Reconstruction services of the affected and the contra-lateral unaffected breast following a mastectomy or lumpectomy is considered medically necessary for all stages of reconstruction of the breast on which the mastectomy has been performed; when surgery and reconstruction of the other breast is to produce a symmetrical appearance; and for prostheses and physical complications of all stages of mastectomy, including lymphedema. 1

2 I., (MCS) will consider medically necessary Breast Reconstruction services of the affected breast after a mastectomy or lumpectomy performed for any medical reason. Medically necessary procedures include: a. Tissue/muscle reconstruction procedures (flaps) transverse rectus abdominus myocutaneous flap, latissimus dorsi (LD) myocutaneous flap, deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric perforator (SIEP)flap, superior or inferior gluteal free flap Ruben s flap b. Capsulotomy i c. Capsulectomy ii d. Implantation of tissue expander e. Implantation of U.S. FDA approved internal breast prosthesis f. Areolar and nipple reconstruction g. Areolar and nipple tattooing h. Reconstructive surgical revisions i. Removal or revision of a breast implant is considered medically necessary when it is removed for one of the following reasons: Mechanical complication of breast prosthesis; including rupture or failed implant, implant extrusion; Infection or inflammatory reaction due to a breast prosthesis; including infected breast implant, or rejection of breast implants; Other complication of internal breast implant; including siliconoma, granuloma, interference with diagnosis of breast cancer, painful capsular contracture with disfigurement. 2

3 II. Medical Card system, Inc., (MCS) will consider medically necessary Breast Reconstruction services of the unaffected/contra-lateral breast, in order to produce a symmetrical appearance after a mastectomy or lumpectomy performed for any medical reason. Medically necessary procedures include: a. Breast reduction by mammoplasty or mastopexy iii b. Augmentation mammoplasty c. Augmentation with implantation of FDA approved internal breast prosthesis when the unaffected breast is smaller than the smallest available internal prosthesis d. Areolar and nipple reconstruction e. Areolar and nipple tattooing f. Reconstructive surgery revisions to produce a symmetrical appearance g. Breast implant removal and subsequent reimplantation when performed to produce a symmetrical appearance h. Capsulotomy j. Capsulectomy III., (MCS) will consider medically necessary the following products when use in association with a covered medically necessary breast reconstruction procedure: a. AlloDerm b. NeoForm Dermis IV., (MCS) considers the following products and procedures to be: Experimental, Investigational or Unproven: a. DermaMatrix Acellular Dermis b. Permacol c. Radiesse d. Strattice reconstructive tissue matrix e. Breast reconstruction after a medically necessary mastectomy when not associated with mastectomy or lumpectomy preformed for breast cancer. 3

4 f. Autologous fat transplant used in association with a breast reconstruction. CODING INFORMATION CPT Codes (List may not be all inclusive) CPT Codes DESCRIPTION Tattoing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less Tattoing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattoing, 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) (use in conjunction with 11921) Replacement of tissue expander with permanent prosthesis Removal of tissue expander(s) without insertion of prosthesis Repair, complex, trunk; 1.1 cm to 2.5 cm Repair, complex, trunk; 2.6 cm to 7.5 cm Repair, complex, trunk; each additional 5 cm or less (list separately in addition to code for primary procedure) (Use in conjunction with 13101) Mastopexy Reduction mammaplasty Mammaplasty, augmentation; without prosthetic implant Mammaplasty, augmentation; with prosthetic implant (for flap or graft, use also appropriate number) Removal of intact mammary implant Removal of mammary implant material Immediate insertion of breast prosthesis following mastopexy, mastectomy or in 4

5 reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Correction of Inverted Nipples 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 Open periprosthetic capsulotomy, breast Periprosthetic capsulectomy, breast Revision of reconstructed breast Preparation of moulage for custom breast implant *Current Procedural Terminology (CPT ) 2013 American Medical Association: Chicago, IL. 5

6 ICD-9 CM Diagnosis Codes (List may not be all inclusive) ICD-9 Codes DESCRIPTION Unspecified Malignant Neoplasm of Skin Of Trunk, Except Scrotum Basal Cell Carcinoma of Skin of Trunk, Except Scrotum Squamous Cell Carcinoma of Skin of Trunk, Except Scrotum Malignant neoplasm of nipple and areola of female breast Malignant neoplasm of central portion of female breast Malignant neoplasm of upper inner quadrant of female breast Malignant neoplasm of lower inner quadrant of female breast Malignant neoplasm of upper outer quadrant of female breast Malignant neoplasm of lower outer quadrant of female breast Malignant neoplasm of axillary tail of female breast Malignant neoplasm of other specified sites of female breast Malignant neoplasm of breast (female), unspecified site Malignant neoplasm of nipple and areola of male breast Malignant Neoplasm of Other and Unspecified Sites of Male Breast Secondary malignant neoplasm of breast (Excludes skin of breast, 198.2) 217 Benign Neoplasm Of Breast Carcinoma In Situ Of Skin Of Trunk Except Scrotum Carcinoma in situ of breast Solitary Cyst Of Breast Diffuse Cystic Mastopathy Fibroadenosis Of Breast Fibrosclerosis Of Breast Mammary Duct Ectasia Other Specified Benign Mammary Dysplasias Benign Mammary Dysplasia Unspecified Mechanical complication due to breast prosthesis Infection and inflammatory reaction due to other internal prosthetic device, implant or graft (i.e. Breast Prosthesis) Other complications due to other internal (biological and/or synthetic) prosthetic 6

7 device, implant and graft V10.3 Personal history of malignant neoplasm; breast V45.71 Acquired absence of breast and nipple (Excludes congenital absence of breast and nipple, 757.6). V50.41 Prophylactic organ removal; breast V51.0 Encounter for breast reconstruction following mastectomy V52.4 Fitting and adjustment of breast prosthesis device and implant *2013 ICD-9-CM For Physicians, VOLUMES I & II, Professional Edition (American Medical Association). HCPCS CODES (List may not be all inclusive) HCPCS Codes C1789 Prosthesis, breast (implantable) Description L8020 L8030 L8031 L8032 L8035 L8039 L8600 S2066 S2067 S2068 Breast prosthesis, mastectomy form Breast prosthesis, silicone or equal, without integral adhesive Breast prosthesis, silicone or equal, with integral adhesive Nipple prosthesis, reusable, any type, each Custom breast prosthesis, post mastectomy, molded to patient model Breast prosthesis, not otherwise specified Implantable breast prosthesis, silicone or equal Breast reconstruction with gluteal artery perforator (GAP) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral Breast reconstruction of a single breast with stacked deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s),including harvesting of the flap (s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral Breast reconstruction with deep inferior epigastric perforator (DIEP) flap, or 7

8 superficial inferior epigastric artery (SIEA) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral *2013 HCPCS LEVEL II Professional Edition (American Medical Association). REFERENCES Federal Breast Reconstruction Law (full document). Generated by the American Society of Plastic Surgeons (ASPS). Signed into Law on October Accessed March 19, Available at URL address: 2. Centers for Medicare and Medicaid Services. Local Coverage Determination (LCD): Cosmetic and Reconstructive Surgery (L30733). Contractor Name: Wisconsin Physicians Service Insurance Corporation. Contractor Number: Original Determination Effective Date: For services performed on or after 11/15/2010. Revision Effective Date: For services performed on or after 01/01/2013. Accessed March 19, Available at URL address: &name=wisconsin+physicians+service+insurance+corporation+(00951%2c+carrier)&s=57&doc Type=Active&bc=AggAAAIAAAAAAA%3d%3d& 3. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Breast Reconstruction Following Mastectomy. Publication Number: Manual Section Number: Effective date: 1/1/1997. Accessed March 19, Available at URL address: 4. Centers for Medicare and Medicaid Services. Retired Local Coverage Determination (LCD) for Cosmetic and Reconstructive Surgery. Contractor name: Wisconsin Physicians Service Insurance Corporation. LCD ID Number: L Effective date: 9/16/2004. Revision effective date: 12/1/2009. Original Determination Ending Date: 11/14/2010. Accessed March 19, Available at URL address: 5. ECRI Institute. DIEP Flap and TRAM Flap for Breast Reconstruction. Published: 2/20/2009. Searched March 19, No longer available at URL address: 6. Puerto Rico: Ley 186 Cirugía Reconstructiva (P. de la C. 186); Texto de Aprobación final por la Cámara, 19 de enero de Accessed March 19, Available at URL address: 7. Senado de Puerto Rico. Informe Positivo sobre el P. del C. 186 sin enmiendas (23 de junio de 2011). Accessed March 19, Available at URL address: or at URL address: 8

9 https://docs.google.com/viewer?a=v&q=cache:sud-- xdg67ij:www.oslpr.org/files/docs/%257bd53b1111-e43a-4061-b7a1-9fdc19550c46%257d.doc+ley+186+cirug%c3%ada+reconstructiva+puerto+rico&hl=es- 419&gl=pr&pid=bl&srcid=ADGEESjVJGdWQ6F3ohlqyLqgcQDtLXvKthXEsk0zRBBJ_gtl1L7WGiwDtOesZPpzIhSGXxPkWM9JvSOtB9Oq1FOZS0VtG_hCM450lmSbS8NiC_06eiNhMhU4TZjUi64K0iQrq4iOA6&sig=AHIEtbRaIWsltqfrx87HiIGlP8Vcttq9aA 8. Women s health and Cancer Rights Act (WHCRA). Federal Breast Reconstruction Law of Accessed March 19, Available at URL address: or at URL address: mens-health-and-cancer-rights-act POLICY HISTORY DATE ACTION COMMENT March 11, 2010 Origination of Policy March 24, 2011 Yearly Review 1. HCPCS Codes added to the policy L8020-L CPT Codes added to the policy March 9, 2012 Yearly Review March 19, 2013 Revised References updated. Added new References, numbers 1, 2, & 7. To the Indications Section: Revised previous indication: Breast implant removal and subsequent reimplantation; and substituted with: Removal or revision of a breast implant is considered medically necessary when it is removed for one of the following reasons: Mechanical complication of breast prosthesis; including rupture or failed implant, implant extrusion; Infection or inflammatory reaction due to a breast prosthesis; including infected breast implant, or rejection of breast implants; Other complication of internal breast implant; including siliconoma, granuloma, interference with diagnosis of breast cancer, painful capsular contracture with disfigurement. To the Coding Information: added the new CPT Code 19355, and the new ICD-9 Codes , 175.9, 217, 232.5, , , , & V

10 This document is for informational purposes only. It is not an authorization, certification, explanation of benefits, or contract. Receipt of benefits is subject to satisfaction of all terms and conditions of coverage. Eligibility and benefit coverage are determined in accordance with the terms of the member s plan in effect as of the date services are rendered., (MCS) medical policies are developed with the assistance of medical professionals and are based upon a review of published and unpublished information including, but not limited to, current medical literature, guidelines published by public health and health research agencies, and community medical practices in the treatment and diagnosis of disease. Because medical practice, information, and technology are constantly changing, Medical Card System, Inc., (MCS) reserves the right to review and update its medical policies at its discretion, (MCS) medical policies are intended to serve as a resource to the plan. They are not intended to limit the plan s ability to interpret plan language as deemed appropriate. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment they choose to provide. i Capsulotomy is a procedure in which part of the "capsule" of scar tissue surrounding a breast implant is removed or the tissue altered or released in some way. ii Capsulectomy is a procedure in which the entire "capsule" of scar tissue surrounding a breast implant is surgically removed. iii Mastopexy or breast lift surgery refers to a group of elective surgical operations designed to lift or change the shape of a person's breasts. 10

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8

Medical 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 information

Breast Reconstruction Surgery

Breast 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 information

Breast Implants and Reconstruction

Breast 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 information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY BREAST RECONSTRUCTION POST MASTECTOMY CLINICAL POLICY Policy Number: SURGERY 095.11 T2 Effective Date: January 1, 2016 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

BREAST RECONSTRUCTION POST MASTECTOMY

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 information

Medical Policy Reconstructive Breast Surgery/Management of Breast Implants

Medical 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 information

Medical Review Criteria Breast Surgeries

Medical Review Criteria Breast Surgeries Medical Review Criteria Breast Surgeries Effective Date: May 25, 2016 Subject: Breast Surgeries Policy: HPHC covers medically necessary breast surgeries including mastectomy, breast reconstruction, reduction

More information

Note: For information related to the medical necessity criteria for mammaplasty procedures, see SURG.00086 Reduction Mammaplasty.

Note: 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 information

Medical Policy Original Effective Date: Revised Date: Page 1 of 8

Medical Policy Original Effective Date: Revised Date: Page 1 of 8 Page 1 of 8 Breast Implant Removal and/or Replacement and Capsulectomy Disclaimer Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on

More information

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE:

SUBJECT: 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 information

Breast Reconstruction Frequently Asked Questions

Breast 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 information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required]

Accelerated 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 information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer

Accelerated 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 information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY 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 information

Breast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus

Breast 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 information

CMS Limitations Guide Mammograms and Bone Density Radiology Services

CMS 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 information

BREAST RECONSTRUCTIVE SURGERY

BREAST 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 information

National Medical Policy

National 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 information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required]

Accelerated 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 information

Dr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery.

Dr. 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 information

ICD-10 Diagnostic Coding for. Breast Reconstruction

ICD-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 information

MEDICAL POLICY No. 91545-R7 BREAST RELATED PROCEDURES*

MEDICAL 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 information

Benefits Collaborative Policy Statement WOMEN S HEALTH SERVICES

Benefits 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 information

Reshaping You. Breast Reconstruction for Breast Cancer Patients

Reshaping 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 information

Chapter 24. Evolution of Procedures

Chapter 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 information

Breast Reconstruction. What You Should Know

Breast 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 information

XXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND

XXXXX 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 information

Direct Current Therapy for Treatment of Hemorrhoids

Direct Current Therapy for Treatment of Hemorrhoids Direct Current Therapy for Treatment of Hemorrhoids [For the list of services and procedures that need preauthorization, please refer to www.mcs.com.pr Go to Comunicados a Proveedores, and click Cartas

More information

Reimbursement Guide: Hernia and Abdominal Wall Repair

Reimbursement Guide: Hernia and Abdominal Wall Repair For more information Ask your Covidien sales representative how procedural solutions for hernia repair can enhance your specialty. Call 1-800-722-8772 today to order product brochures, DVDs or detailed

More information

Corporate Medical Policy Breast Surgeries

Corporate 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 information

Name of Policy: Reconstructive versus Cosmetic Surgery

Name 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 information

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328)

Local 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 information

CHOICES IN BREAST RECONSTRUCTION

CHOICES IN BREAST RECONSTRUCTION CHOICES IN BREAST RECONSTRUCTION A Guide to Surgical Options and the Natrelle Collection Please see Indications and Important Safety Information inside. 1 CHOOSING BREAST RECONSTRUCTION The purpose of

More information

DEPARTMENT 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 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 information

Breast Reconstructive Surgery BREAST RECONSTRUCTIVE SURGERY HS-280. Policy Number: HS-280. Original Effective Date: 2/5/2015. Revised Date(s): N/A

Breast 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 information

Non-Emergency Non-Ambulance Services - TRANSCITA

Non-Emergency Non-Ambulance Services - TRANSCITA Non-Emergency Non-Ambulance Services - TRANSCITA [Preauthorization Required] Medical Policy: MP-TRANS-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products subscribed

More information

BREAST RECONSTRUCTION/REMOVAL AND REPLACEMENT OF IMPLANTS

BREAST RECONSTRUCTION/REMOVAL AND REPLACEMENT OF IMPLANTS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline must be read in its

More information

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.

Links 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 information

Breast Reconstruction After Mastectomy

Breast 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 information

Rotation 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 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 information

transformation M I C R O S U R G I C A L B R E A S T R E C O N S T R U C T I O N

transformation M I C R O S U R G I C A L B R E A S T R E C O N S T R U C T I O N ransformation M I C R O S U R G I C A L B R E A S T R E C O N S T R U C T I O N T H E L AT ES T M I C R O S U R G I C A L T E C H N I Q U ES I N B R E A S T R E C O N S T R U C T I O N Dr. Ali Sadeghi

More information

Breast Reconstruction

Breast Reconstruction Breast Reconstruction Princess Margaret An information booklet for women who are thinking about having breast reconstruction surgery Breast reconstruction is a personal choice. This booklet gives you information

More information

BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required]

BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required] BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required] Medical Policy: MP-RX-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products

More information

The spectrum of breast surgery

The spectrum of breast surgery The spectrum of breast surgery at SCPMG Cissy Tan, M.D. Regional Chief of Plastic Surgery, SCPMG Breast/Mastectomy Reconstruction Breast reduction Management of breast implant problems Gynecomastia 1 Breast

More information

BREAST SURGERY POLICY

BREAST SURGERY POLICY BREAST SURGERY POLICY This policy applies to all patients registered with a General Practitioner within NHS Wiltshire. Background NHS Wiltshire does not normally fund cosmetic procedures solely to improve

More information

Oncoplastic breast surgery e A guide to good practice

Oncoplastic 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 information

Corporate Medical Policy Breast Surgeries

Corporate Medical Policy Breast Surgeries Corporate Medical Policy Breast Surgeries File Name: Origination: Last CAP Review: Next CAP Review: Last Review: breast_surgeries 1/2000 9/2012 9/2013 9/2012 Description of Procedure or Service Mastectomy

More information

What You Need to Know About Breast Reconstruction Surgery

What 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 information

BREAST CANCER WHAT ARE MY SURGICAL OPTIONS?

BREAST CANCER WHAT ARE MY SURGICAL OPTIONS? BREAST CANCER WHAT ARE MY SURGICAL OPTIONS? Contents: The aims of surgery Know your surgical options Breast reconstruction Questions to ask your surgeon The aims of surgery Every woman is different and

More information

INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001

INFORMATION 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 information

It is important that you read this information carefully and completely.

It 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

If 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.

If 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 information

THE DECISION GUIDE TO BREAST RECONSTRUCTION

THE 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 information

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required]

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Medical Policy: MP-ME-05-09 Original Effective Date: February 18, 2009 Reviewed: April 22, 2011 Revised: This policy applies to products

More information

Autologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation

Autologous 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 information

Breast Reconstruction After Mastectomy

Breast 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 information

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests

Medicare 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 information

Premier ADvantage free Limited Warranty on. MENTOR MemoryGel Breast Implants and MemoryShape Breast Implants

Premier ADvantage free Limited Warranty on. MENTOR MemoryGel Breast Implants and MemoryShape Breast Implants Premier ADvantage free Limited Warranty on MENTOR MemoryGel Breast Implants and MemoryShape Breast Implants YOUR PEACE-OF-MIND COMES FIRST Partnering with the right surgeon and choosing the best implants

More information

Integumentary System Individual Exercises

Integumentary 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 information

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8 PGY-6 Round on all plastic surgery inpatients every day. Assess progress of patients and identify real or potential problems. Review patients progress with attending physicians daily and participate in

More information

Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction

Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction About This Brochure This brochure is intended to provide you with a high level overview of the facts about

More information

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery

Medical 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 information

Quick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants

Quick 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 information

Fat Injection to Correct Contour Deformities in the Reconstructed Breast

Fat 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 information

Cigna Medical Coverage Policy

Cigna Medical Coverage Policy Cigna Medical Coverage Policy Subject Breast Reconstruction Following Mastectomy or Lumpectomy Table of Contents Coverage Policy... 1 General Background... 3 Coding/Billing Information... 19 References...

More information

Patient information. Breast Asymmetry. Breast Services Directorate PIF 054 V5

Patient information. Breast Asymmetry. Breast Services Directorate PIF 054 V5 Patient information Breast Asymmetry Breast Services Directorate PIF 054 V5 Nobody has breasts that are exactly the same size. However, if this is very noticeable, surgery is often helpful. It is usually

More information

Surgery Choices. National Cancer Institute. For Women with DCIS or Breast Cancer. National Institutes of Health

Surgery 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 information

Protocol. Reconstructive Breast Surgery/Management of Breast Implants

Protocol. Reconstructive Breast Surgery/Management of Breast Implants Protocol Reconstructive Breast Surgery/Management of Breast Implants Medical Benefit Effective Date: 04/01/14 Next Review Date: 11/16 Preauthorization Yes Review Dates: 02/07, 02/08, 01/09, 01/10, 01/11,

More information

APPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE

APPENDIX 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 information

Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants

Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants 1 Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled

More information

PANNICULECTOMY & BODY CONTOURING PROCEDURES

PANNICULECTOMY & 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 information

Protocol. Reconstructive Breast Surgery/Management of Breast Implants

Protocol. Reconstructive Breast Surgery/Management of Breast Implants Protocol Reconstructive Breast Surgery/Management of Breast Implants Medical Benefit Effective Date: 04/01/14 Next Review Date: 11/15 Preauthorization Yes Review Dates: 02/07, 02/08, 01/09, 01/10, 01/11,

More information

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: April 13, 2016 Clinical Documentation and Prior Authorization Coverage Guideline, No Prior Required Authorization Applies to:

More information

INFORMED-CONSENT BREAST AUGMENTATION

INFORMED-CONSENT BREAST AUGMENTATION RICHARD A. BARTLETT, M.D. Board Certified-American Board of Plastic Surgery Member-American Society of Plastic Surgeons Member-American Society for Aesthetic Plastic Surgery INFORMED-CONSENT BREAST AUGMENTATION

More information

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can:

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can: Breast Augmentation What is Breast Augmentation? Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume

More information

Breast Reconstruction Surgery

Breast 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 information

Page 1 of 7 Patient s Initials 10-01-00 version

Page 1 of 7 Patient s Initials 10-01-00 version INFORMED-CONSENT-AUGMENTATION MAMMAPLASTY INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about augmentation mammaplasty, its risks, and alternative treatments.

More information

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368 COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368 GROUP SPECIFIED DISEASE INSURANCE Outline of Coverage (Applicable to

More information

COPYRIGHT ASPS. Breast Augmentation. The Symbol of Excellence in Plastic Surgery

COPYRIGHT 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 information

PROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL

PROPERTY 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 information

Clinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center

Clinical 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 information

Prior Authorization Code List August v1 Rev (08/07/2015) Procedures and Additional Information

Prior Authorization Code List August v1 Rev (08/07/2015) Procedures and Additional Information Prior Authorization Code List August 7 2015 v1 Rev (08/07/2015) Procedures and Additional Information Services Codes for UnitedHealthcare Military & Veterans Adjunctive Dental ALL- 21031 D2420 D4275 D6068

More information

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005 Patient Presentation Patient seeks exceptional procedure Clinical assessment: Psychology criteria (see Appendix 1) Exceptional physical criteria (see Appendix 2) Patient meets criteria Patient does not

More information

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services Coding and Payment Guide for Dental Services A comprehensive coding, billing, and reimbursement resource for dental services 2011 Contents Introduction...1 Coding Systems... 1 Claim Forms... 2 Contents

More information

Coding Skin Procedures in the Office Setting. Disclaimer

Coding Skin Procedures in the Office Setting. Disclaimer Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC All Rights Reserved AAPC 1 Disclaimer The information you are receiving today is based

More information

Oct 2005 ISBN: 1-873820-55-0. Breast Implants. Information for women considering breast implants

Oct 2005 ISBN: 1-873820-55-0. Breast Implants. Information for women considering breast implants Oct 2005 ISBN: 1-873820-55-0 Breast Implants Information for women considering breast implants Forward Preface It gives me great pleasure to support this publication as part of the Health Promotion services

More information

MEDICAL MANAGEMENT POLICY

MEDICAL 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 information

Cancer Insurance: Keep your focus on winning the battle

Cancer Insurance: Keep your focus on winning the battle Jeremy Cato IT Test Engineer Cancer Insurance: Keep your focus on winning the battle 1 in 2 men in the U.S. have a chance of developing cancer. 1 1 in 3 women in the U.S. have a chance of developing cancer.

More information

Looking for answers about breast reconstruction?

Looking for answers about breast reconstruction? Looking for answers about breast reconstruction? Start here. Start today. { 1 } { 2 } Taking the mystery out of breast reconstruction If you or someone you care about is considering breast reconstruction

More information

A New Dimension in Supplemental Cancer Insurance

A New Dimension in Supplemental Cancer Insurance A New Dimension in Supplemental Cancer Insurance Underwritten by: Administrative Office: P.O. Box 1604 Duncan, OK 73534 Toll Free: 1-800-366-8354 A Promise In an era where many financial services companies

More information

What are the chances that I might be diagnosed with cancer?

What are the chances that I might be diagnosed with cancer? New Beginnings Schools Foundation Choosing to focus on winning the battle What are the chances that I might be diagnosed with cancer? While 1 in 3 Americans are expected to get cancer in their lifetime1,

More information

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services Coding and Payment Guide for Dental Services A comprehensive coding, billing, and reimbursement resource for dental services 2014 Contents Introduction...1 Coding Systems... 1 Claim Forms... 2 Contents

More information

MEDICAL POLICY No R0 GENDER REASSIGNMENT SURGERY FOR MEDICARE MEMBERS

MEDICAL POLICY No R0 GENDER REASSIGNMENT SURGERY FOR MEDICARE MEMBERS GENDER REASSIGNMENT SURGERY FOR MEDICARE MEMBERS Effective Date: January 1, 2016 Review Dates: 8/15 Date Of Origin: August 12, 2015 Status: New I. POLICY/CRITERIA Gender reassignment surgery, including

More information

Group Cancer Insurance

Group Cancer Insurance Group Cancer Insurance DunderMifflin announces Cancer Insurance protection Focus on winning the battle Understanding the risk is crucial to preparing to win the battle. Even with significant advances in

More information

Policy #: 111 Latest Review Date: January 2010

Policy #: 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 information

National Mastectomy and Breast Reconstruction Audit. Prospective Audit Dataset. Final Version

National 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 information

Early-stage Breast Cancer Treatment: A Patient and Doctor Dialogue

Early-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 information

Breast Reconstruction

Breast 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 information

CHAPTER 9. Plastic and Reconstructive Surgery of the Breast

CHAPTER 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 information

2015 Hernia & Abdominal Wall Repair (AWR) Surgery Medicare Reimbursement Coding Guide Effective January 1, 2015

2015 Hernia & Abdominal Wall Repair (AWR) Surgery Medicare Reimbursement Coding Guide Effective January 1, 2015 2015 Reimbursement Coding Guide Effective January 1, 2015 MEDICARE NATIONAL AVERAGE RATES AND ALLOWABLES (NOT ADJUSTED FOR GEOGRAPHY) CPT * HCPCS Code COMPONENT SEPARATION Procedure Description 15734 Muscle,

More information