Medical Review Criteria Breast Surgeries
|
|
- Ashlee Pierce
- 7 years ago
- Views:
Transcription
1 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 mammoplasty, breast implant removal, and inverted nipple repair. Mastectomy (including prophylactic mastectomy) is covered when the PCP or attending provider determines that the procedure is medically necessary. 1 Post-mastectomy/post-lumpectomy breast reconstruction, and surgical and reconstructive procedures to the contralateral breast, are covered in accordance with the Women s Health & Cancer Rights Act of (i.e., to repair or restore appearance of one or both breasts, and/or for physical complications [e.g., lymphedema] of all stages of mastectomy or lumpectomy). Reconstructive procedures unrelated to mastectomy or lumpectomy are covered when HPHC determines a requested procedure is reasonable and medically necessary for the individual member. Removal of breast implants is covered when HPHC determines the procedure is reasonable and medically necessary for the individual member. (HPHC does not cover the removal of intact breast implants solely for a suspected benefit for prophylaxis against auto-immune disease, connective tissue disease or breast cancer, or because an intact implant has shifted as these indications are considered investigational and unproven.) Criteria used to review requests for gynecomastia surgery are described in HPHC s Gynecomastia Surgeries Medical Review Criteria. Authorization: Prior authorization is required for the following procedures requested for members enrolled in HPHC commercial (HMO, POS, or PPO) products: Breast Reconstruction Breast Implant Removal Inverted Nipple Repair 3 Breast Reduction/Reduction Mammoplasty 1 Prophylactic mastectomy, including total (simple) mastectomy or subcutaneous mastectomy, is typically considered medically necessary to prevent or reduce the risk of breast cancer in: Females with a BRCA1 or BRCA2 mutation confirmed by genetic testing Females with a first or second-degree relative (blood relative who shares at least 25-50% of the same genes) with a known BRCA1 or BRCA2 mutation; Males or females with a personal history of breast cancer; or Females with a personal history of ovarian cancer. 2 The Womens Health and Cancer Rights Act of 1998 (WHCRA) requires coverage for certain services related to mastectomy/lumpectomy, whether or not the surgery was covered by HPHC. (Nothing in the law limits WHCRA rights to women or to cancer patients.) Coverage includes reconstruction of the affected breast and nipple in a manner determined in consultation between the member and attending physician, surgical reconstruction of the unaffected breast (including reduction or augmentation of the non-diseased breast) to produce a symmetrical appearance, and breast prostheses. 3 Other nipple procedures are covered only when they are a medically necessary part of an authorized breast reconstruction procedure, and relevant are met. Breast Surgeries Page 1 of 6
2 Prior authorization is not required for mastectomy procedures including prophylactic mastectomy. Criteria: Procedure Criteria Breast Reconstruction Post-Mastectomy/Post-Lumpectomy Reconstruction including Breast Reduction, Augmentation, and/or Implant Use: Authorized when documentation confirms procedure is requested to repair or restore the appearance of one or both breasts, or for physical complications (e.g., lymphedema) after ANY of the following: Any stage of mastectomy, lumpectomy or excisional biopsy including evaluation and treatment of ANY of the following: Breast cyst Benign or malignant breast mass Aberrant breast tissue Duct lesion Nipple or areolar lesion Excision of chest wall tumor (including ribs) with or without plastic reconstruction. Reconstruction Unrelated to Mastectomy/Lumpectomy 4 : Reconstruction of the affected breast is authorized when documentation (including photographs*) confirms ANY of the following: Significant breast asymmetry (i.e., at least a 2-cup difference in breast size) in a female member who has reached physical maturity (age 16 years or older); Severe disfigurement resulting from surgical complications, trauma, disease, or Poland Syndrome. Reconstruction of the contra-lateral breast is NOT authorized unless documentation clearly demonstrates the medical necessity of the requested procedure. * Mailed or ed photo documentation is required. Faxed photos of poor quality cannot be used to make a determination of medical necessity. Reconstruction After Removal of Breast Implants: Authorized when documentation confirms ANY of the following: Original implants were inserted following an authorized breast reconstruction procedure; Prior to the implant removal, the member met HPHC s Medical Review Criteria for breast reconstruction (above). Reconstruction after removal of breast implants in other situations, is considered cosmetic 5 and not covered (even if HPHC determines removal of the breast implant is medically necessary). 4 Coverage for medically necessary reconstructive surgery unrelated to mastectomy/lumpectomy is typically limited to one procedure per member per lifetime. Requests for subsequent procedures are reviewed and decided on a case by case basis. 5 Cosmetic surgery is surgery performed primarily to reshape or improve the patient's appearance. Most cosmetic services are not considered medically necessary, even if intended to improve an individual s emotional well-being or treat a mental health condition. Breast Surgeries Page 2 of 6
3 Procedure Breast Implant Removal Insertion of replacement implants is not authorized unless Breast Reconstruction criteria are met. Criteria Post-Mastectomy/Post-Lumpectomy Implant Removal: Authorized when documentation confirms procedure is requested to repair or restore the appearance of one or both breasts, or for physical complications after ANY stage of mastectomy, lumpectomy or excisional biopsy Implant Removal Unrelated to Mastectomy/Lumpectomy Removal of a silicone or saline breast implant is authorized when documentation confirms ANY of the following: Implant interferes with breast cancer screening Removal is needed to facilitate breast cancer treatment Removal is required to treat a persistent or recurrent infection (local or systemic) that is secondary to the breast implant, and refractory to medical management including antibiotics Removal is required to treat a capsular contracture (Baker Grade III- IV 6 ) that is causing pain, and is refractory to medical management. Removal of a ruptured silicone breast implant (intracapsular or extracapsular rupture) is authorized only when rupture is confirmed by diagnostic imaging (e.g., MRI or other conclusive study). Removal of a ruptured saline implant is not considered medically necessary in the absence of other complications. When criteria for the removal of a unilateral breast implant are met, removal of the contralateral implant is authorized only if the procedure independently meets implant removal criteria (above). Reduction Mammoplasty 7 Post-Mastectomy/Post-Lumpectomy Reduction Mammoplasty: Authorized when documentation confirms procedure is requested to repair or restore the appearance of one or both breasts, or for physical complications (e.g., lymphedema) after ANY of the following: Any stage of mastectomy, lumpectomy or excisional biopsy including evaluation and treatment of ANY of the following: Breast cyst Benign or malignant breast mass Aberrant breast tissue Duct lesion Nipple or areolar lesion Reduction Mammoplasty Unrelated to Mastectomy/Lumpectomy 6 Capsular contracture defined using Baker grades I through IV: Grade I : Breast is normally soft and looks natural. Grade II: Breast is a little firm but looks normal. Grade III: Breast is firm and looks abnormal. Grade IV: Breast is hard, painful, and looks abnormal. 7 Coverage for reduction mammoplasty other than post-mastectomy/lumpectomy reduction is typically limited to one procedure per member per lifetime. Requests for additional procedures are reviewed and decided on a case by case basis. Breast Surgeries Page 3 of 6
4 Procedure Criteria Authorized when documentation confirms the presence of severe breast hypertrophy in a female aged 16 years or older who has reached physical maturity and ALL the following criteria are met: 1. The member s physical symptoms are significant and persistent, and directly attributed to breast hypertrophy; 2. The member s symptoms have interfered with activities of daily living for at least six months, and are unrelieved despite conservative management (e.g., NSAIDS, support wear, physical therapy, optimal medical treatment); 3. The amount of breast tissue expected to be removed from each breast can reasonably be expected to improve the patient s symptoms, and meets or exceeds the amounts outlined in the Table for Reduction Mammoplasty Criteria (below).** In cases of breast asymmetry, bilateral reduction mammoplasty may be authorized when the amount of breast tissue expected to be removed from the larger breast meets criteria. **HPHC reserves the right to request the post-operative pathology report to confirm the amount of breast tissue that was removed from each breast. Table for Reduction Mammoplasty Criteria 8 The individual s body surface area (BSA) is calculated using the DuBois & DuBois Formula 9, BSA (m 2 ) = x (height x weight ) where height is in centimeters and weight is in kilograms. Member s body surface area (M 2) Weight (in grams) of Tissue to Be Removed The constructed table is adapted from a study by Paul Schnur et al. Reduction Mammoplasty: Cosmetic or Reconstructive Procedure. The table uses the lower 15 percentile weight of breast tissue removed in relation to body surface area delineated by Schnur, and then rounds this to the nearest 50 grams. 9 An on line calculator is available at Breast Surgeries Page 4 of 6
5 Member s body surface area (M 2) Weight (in grams) of Tissue to Be Removed Coding: Codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive Mastopexy Unilateral reduction mammoplasty Bilateral breast reduction mammoplasty Mammoplasty, augmentation; without prosthetic implant With prosthetic implant Removal of intact mammary implant Removal of mammary implant material Correction of Inverted Nipple Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areolar reconstruction Correction of inverted nipples Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Breast reconstruction with latissimus dorsi flap, with or 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; 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 Unlisted procedure, breast Exclusions: HPHC does not cover listed breast surgeries when criteria above are not met. In addition, HPHC does not cover: Cosmetic procedures (e.g., mastopexy, correction of inverted nipple) that are not part of an authorized postmastectomy breast reconstruction procedure; Removal of intact breast implants solely for a suspected benefit for prophylaxis against auto-immune disease, connective tissue disease or breast cancer; Removal of an intact breast implant solely because it has shifted. Revisions: Approved by UMCPC: 5/25/16 Breast Surgeries Page 5 of 6
6 Revised: 9/02, 10/03, 10/04, 12/05, 1/06, 2/07, 2/08, 3/08, 4/09, 4/10, 5/11, 4/12, 4/13, 6/14, 6/15; 5/16 Initiated: 7/01 Summary of Changes Date Changes 5/16 Minor formatting edits. Updated references 6/15 Reformatted, minor language changes. Add coding profile. Add ASPS documents to references. Delete coverage for repair of inverted nipple unless part of an authorized post-mastectomy breast reconstruction procedure. Relevant Mandates: U.S. Women's Health and Cancer Right Act of 1998 Maine Title 24-A MRSA 4237 NH RSA 417-D:2-b References: Reduction Mammoplasty: ASPS Recommended Insurance Coverage Criteria for Third-Party Payers (accessed 5/18/15): Breast Reconstruction for Deformities Unrelated to Cancer Treatment: ASPS Recommended Insurance Coverage Criteria for Third-Party Payers ): professionals/health-policy/insurance/breast-reconstruction-for-deformities-unrelated-to-cancer- Treatment.pdf Reduction mammoplasty - the sliding scale revisited. Ann Plastic Surg, Jan 1999; 42(1) Reduction mammoplasty: cosmetic or reconstructive procedure. Schnur, Paul L, et al., "Reduction Mammoplasty: Cosmetic or Reconstructive Procedure?" Ann Plastic Surg. Sept 1991; 27 (3): Hansen, J., Chang, S. Overview of breast reduction. In: UpToDate, Post, TW (ed), Waltham, MA, Nahabedia, M. Overview of breast reconstruction. In: UpToDate, Post, TW (ed), Waltham, MA, Chagpar, AB. Contralateral prophylactic mastectomy. In: UpToDate, Post, TW (ed), Waltham, MA, Breast Surgeries Page 6 of 6
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 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 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 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 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 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 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 informationBREAST 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 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 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 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 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 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 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 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 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 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 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 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 informationSientra 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 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 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 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 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 informationBreast Implants: Local Complications and Adverse Outcomes
Breast Implants: Local Complications and Adverse Outcomes This booklet highlights the most common problems associated with silicone gel-filled and saline-filled breast implants: those that occur in the
More informationPlastic 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 informationImportant 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 informationUnderstanding Your Surgical Options For Breast Cancer
RADIATION THERAPY SYMPTOM MANAGEMENT CANCER INFORMATION Understanding Your Surgical Options For Breast Cancer In this booklet you will learn about: Role of surgery in breast cancer diagnosis and treatment
More informationHereditary Breast and Ovarian Cancer (HBOC)
Oxford University Hospitals NHS Trust Oxford Regional Genetic Department Hereditary Breast and Ovarian Cancer (HBOC) Information for women with an increased lifetime risk of breast and ovarian cancer What
More informationTOM J. POUSTI, MD, F.A.C.S. PLASTIC AND RECONSTRUCTION SURGERY
TOM J. POUSTI, MD, F.A.C.S. PLASTIC AND RECONSTRUCTION SURGERY INFORMED CONSENT FOR BREAST AUGMENTATION SURGERY INSTRUCTIONS This is an informed consent document that has been prepared to help inform you
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 informationINFORMED-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 informationSPECIALISED SERVICES POLICY: CP69 BREAST SURGERY PROCEDURES
SPECIALISED SERVICES POLICY: CP69 BREAST SURGERY PROCEDURES Document Author: Specialised Planner Executive Lead: Director of Planning Approved by: WHSSC Joint Committee Issue Date: 16 July 2013 Review
More informationBreast Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives
NHS Dorset Clinical Commissioning Group Breast Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives POLICY TRAIL AND VERSION CONTROL SHEET: Protocol Reference: Version:
More informationIllinois Insurance Facts Illinois Department of Insurance
Illinois Insurance Facts Illinois Department of Insurance Women s Health Care Issues Revised August 2012 Note: This information was developed to provide consumers with general information and guidance
More informationPage 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 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 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 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 informationLooking 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 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 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 informationPatient 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 informationBREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte TYPES OF IMPLANTS saline round implants high profiles low profile shaped
BREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte has 20 years of experience with breast enlargement including axillary incisions and gel implants. Dr. Van Raalte is the first Quad City
More informationImportant Information for Augmentation Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants
Important Information for Augmentation Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants 1 Important Information for Augmentation Patients about Mentor MemoryGel Silicone gel-filled
More informationBreast 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 informationCONSENT FOR BREAST IMPLANT REMOVAL
CONSENT FOR BREAST IMPLANT REMOVAL GENERAL INFORMATION The removal of breast implants that have been placed either for cosmetic or reconstructive purposes is a surgical operation. Breast implant removal
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 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 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 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 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 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 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 informationImportant Information for Women About Breast Augmentation with INAMED Silicone-Filled Breast Implants
Augmentation Important Information for Women About Breast Augmentation with INAMED Silicone-Filled Breast Implants Table of Contents Section Page Glossary...1 1. Considering Silicone Gel-filled Breast
More informationA Girlfriend s Guide. Breast Augmentation WWW.RPSMD.COM
A Girlfriend s Guide to Breast Augmentation 1 Your Breast Augmentation Surgery: This is an important decision that you are considering. Have you always thought about increasing the size of your breasts,
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 informationNATRELLE 410 Highly Cohesive
Breast Augmentation NATRELLE 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants Important Factors Breast Augmentation Patients Should Consider Highly Cohesive Anatomically Shaped Silicone-Filled
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 informationEvaluation and Management of the Breast Mass. Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003
Evaluation and Management of the Breast Mass Gary Dunnington,, M.D. Department of Surgery Internal Medicine Ambulatory Conference December 4, 2003 Common Presentations of Breast Disease Breast Mass Abnormal
More informationBreast Augmentation Primer
Breast Augmentation Primer Breast augmentation is typically a very rewarding procedure. In order to achieve the highest level of patient satisfaction, many decisions must be carefully made. We have put
More informationA 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 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 informationOncoplastic Surgery: ACreativeApproach to Breast Cancer Management
Oncoplastic Surgery: ACreativeApproach to Breast Cancer Management Gail S. Lebovic, MA, MD KEYWORDS Oncoplastic surgery Breast cancer Skin-sparing mastectomy Reconstruction HISTORICAL PERSPECTIVE History
More informationCAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician.
Product Insert Data Sheet MENTOR MEMORYGEL SILICONE GEL-FILLED BREAST IMPLANTS 102872-001 Rev. C Effective November 2006 102872-001 Rev A effective June 2006 CAUTION: Federal (USA) law restricts this device
More informationINFORMED-CONSENT-OPEN CAPSULECTOMY AND BREAST IMPLANT EXCHANGE
INFORMED-CONSENT-OPEN CAPSULECTOMY AND BREAST IMPLANT EXCHANGE Instructions This is an informed-consent document that has been prepared to help inform you about open capsulectomy and breast implant exchange,
More informationSALINE-FILLED BREAST IMPLANT SURGERY: MAKING AN INFORMED DECISION
SALINE-FILLED BREAST IMPLANT SURGERY: MAKING AN INFORMED DECISION So You re Considering Saline-Filled Breast Implant Surgery The purpose of this brochure is to assist you in making an informed decision
More informationinding the fit that s right for you. Your Surgery Planner For Augmentation Surgery with Natrelle Silicone-Filled Breast Implants
inding the fit that s right for you. Your Surgery Planner For Augmentation Surgery with Natrelle Silicone-Filled Breast Implants L Place Your Device Identification Card(s) Here R A c c e p t a n c e O
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 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 informationFrequently Asked Questions About Ovarian Cancer
Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues
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 informationOct 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 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 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 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 informationAugmentation. Style 68HP BREAST AUGMENTATION WITH NATRELLE SILICONE-FILLED NATRELLE INSPIRA BREAST IMPLANTS CRYSTAL AMBER CASEY MINELA MINELA CASEY
Augmentation BREAST AUGMENTATION WITH NATRELLE SILICONE-FILLED BREAST AMBER IMPLANTS CRYSTAL AND Nurse NATRELLE Style 68HP Singer NATRELLE Style 20 NATRELLE INSPIRA BREAST IMPLANTS MINELA Student NATRELLE
More informationWomen s Health and Cancer Rights Act
The following is a required annual notification: CATHOLIC CHARITIES BUREAU, INC. COMPREHENSIVE MAJOR MEDICAL HEALTH CARE PLAN AMENDMENT Women s Health and Cancer Rights Act Under the federal Women s Health
More informationBreast Implant Information Booklet. 4th edition
Breast Implant Information Booklet 4th edition This booklet has been prepared to provide guidance for persons considering the use of silicone gel-filled breast implants. These implants are associated with
More informationNicole Kounalakis, MD
Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations
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 informationIntroduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too.
Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast
More informationFlorida Breast Health Specialists Breast Cancer Information and Facts
Definition Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer: Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to
More informationGuide to Understanding Breast Cancer
An estimated 220,000 women in the United States are diagnosed with breast cancer each year, and one in eight will be diagnosed during their lifetime. While breast cancer is a serious disease, most patients
More informationNORCOM COMMISSIONING POLICY. Specialist Plastic Surgery Procedures
NORCOM North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium NORCOM COMMISSIONING POLICY Specialist Plastic Surgery Procedures January 2007 Review Date: January 2009 Prepared by Rotherham
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 Health Program
Breast Health Program Working together, for your health. Breast Health Program The Breast Health Program at The University of Arizona Cancer Center offers patients a personalized approach to breast cancer,
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 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 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 informationFDA Update on the Safety of Silicone Gel-Filled Breast Implants
FDA Update on the Safety of Silicone Gel-Filled Breast Implants June 2011 Center for Devices and Radiological Health U.S. Food and Drug Administration FDA Update on the Safety of Silicone Gel-Filled Breast
More informationGuideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer
Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11
More informationINTERNATIONAL. Breast Augmentation. Options
INTERNATIONAL Breast Augmentation Options Important Safety Information: Mentor MemoryGel and Mentor saline-filled breast implants are indicated for breast augmentation - in women who are at least 18 years
More informationBRCA Genes and Inherited Breast and Ovarian Cancer. Patient information leaflet
BRCA Genes and Inherited Breast and Ovarian Cancer Patient information leaflet This booklet has been written for people who have a personal or family history of breast and/or ovarian cancer that could
More informationProtocol. 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 informationBreast Cancer Treatment Guidelines
Breast Cancer Treatment Guidelines DCIS Stage 0 TisN0M0 Tamoxifen for 5 years for patients with ER positive tumors treated with: -Breast conservative therapy (lumpectomy) and radiation therapy -Excision
More informationRestoring breast volume and shape after breast cancer surgery by injecting the patient s own fat
Issue date January 2012 Understanding NICE guidance Information for people who use NHS services Restoring breast volume and shape after breast cancer surgery by injecting the patient s own fat NICE interventional
More informationScreenWise. Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015
ScreenWise Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015 ScreenWise Three programs working together to bring quality screening services to Oregon residents Why we all do this work
More information