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L.7.01.424
To replace a breast that has been surgically removed, a breast mound must first be reconstructed using alloplastic (non-self) materials, such as implants; or autogenous (self) tissues, such as flaps and grafts. A new nipple/areola can be reconstructed when the breast mound has "settled" and its final position has been established. Breast reconstruction may be performed immediately (at the time of mastectomy), or delayed (several months or even years following mastectomy). The timing should be determined by the surgeon, in consultation with the patient and other involved physicians.
A variety of techniques for breast reconstruction are available to accommodate the wide range of deformities resulting from mastectomy. Choice of the appropriate surgical technique must be made by the surgeon and will depend on the individual circumstances and needs of the patient.
Currently accepted techniques for reconstruction of a breast include:
Insertion of a Breast Implant
In some patients with adequate soft tissues, insertion of an alloplastic breast prosthesis underneath the skin or muscle of the chest will create a satisfactory breast mound.
Tissue Expansion
In some patients the skin covering their chest does not have enough elasticity to accommodate insertion of a breast prosthesis. To increase the amount of soft tissue available, a silicone tissue expander is placed beneath the skin or chest muscle. Over a period of time, saline is injected into the expander, causing the tissue to stretch. A second surgical procedure is usually required to remove the tissue expander and replace it with a permanent breast prosthesis.
Regional Tissue Transfer
When muscle and skin are insufficient or missing, it may be necessary to use an adjacent skin flap from the chest, abdomen, or back. The transverse rectus abdominis musculocutaneous (TRAM) flap is frequently used. It has the advantage of providing relatively large amounts of tissue for reconstruction, usually avoiding implant use, and leaving an acceptable donor site defect. Microsurgical techniques may be useful to augment TRAM-flap circulation when necessary to ensure flap viability. The latisimus dorsi flap is another regional flap that is used frequently. This flap, while it provides additional tissue, often requires an implant as well to provide adequate contour.
Distant Tissue Transfer (Free-Flap)
Sometimes, when adequate local or regional tissues are unavailable for reconstruction, it is necessary to use a free-flap transfer. This technique involves transplanting distant skin and underlying tissue along with the veins and arteries and reconnecting this flap to a "new" local blood supply under microscopic magnification. Microsurgical free-tissue transfer, using one of several donor sites, may be used to avoid implants in certain individuals. However, placement of a breast implant may be necessary as an adjunct to any flap procedure when insufficient tissue is obtained.
Reconstruction of the Nipple/Areolar Complex
Secondary surgery to provide optimal results involves restoration of a simulated nipple and surrounding areolar complex on the reconstructed breast mound. Available techniques include skin grafts, flaps, tattooing, and --occasionally-- transplantation of tissues from the opposite breast.
Surgery on the Opposite Breast
Because of the limitations of the current available techniques, reconstruction of a new breast mound often results in a shape and contour that is significantly different from the remaining, opposite (contralateral) breast. Because the breasts are paired organs, reconstructive surgery on the contralateral breast is therefore often necessary to achieve the best possible match of size and configuration. These surgical procedures may include reduction mammoplasty (reduction of the size of the breast), mastopexy (correction of the drooping breast) or implant mammoplasty (augmentation).
Miscellaneous Procedures
Frequently, additional surgical procedures may be required to achieve an optimal final reconstructive result. These may include excision of redundant tissue, repositioning of an implant, release of internal scar tissue, creation of an inframammary fold, scar revision, and other tissue rearrangement.
In accordance with the Women's Health and Cancer rights Act of 1998 (WHCRA), all group health insurance as well as individual contracts that provide coverage for a mastectomy must comply with the following requirements:
If the Member elects reconstructive breast surgery connected with any medically necessary mastectomy, benefits will be provided for the following covered services:
Reconstruction of the breast on which the mastectomy was performed;
Surgery on the unaffected breast that is required to "produce a symmetrical appearance", and
Prostheses and treatment of complications of any state of a mastectomy, including lymphedema
Documentation should be provided which supports that the mastectomy was performed due to a disease process, congenital absence of one breast (Poland's Syndrome) or to restore bodily function or correct deformity resulting from disease, trauma or complication of previous surgery.
Breast reconstruction following mastectomy is performed to create a simulated breast and restore a sense of "wholeness" to the individual. Since breasts are paired organs, the ultimate result is to achieve bilateral symmetry. This may require surgery on the contralateral breast in cases of unilateral mastectomy. Restoration of both breasts following mastectomy is considered reconstructive and should be eligible for coverage.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
2/1993: Approved by Medical Policy Advisory Committee (MPAC).
10/1998: Women's Health and Cancer Rights Act of 1998 (WHCRA).
4/5/2001: Policy reviewed; Managed Care Requirements deleted.
7/16/2001: CPT codes 11960 and 11970 deleted; 19357 added.
4/18/2002: Type of Service and Place of Service deleted.
5/14/2002: Code Reference section updated; CPT codes 19180, 19182, 19328 and 19330 deleted.
9/4/2002: Code Reference section updated; CPT code 11970 re-added.
11/1/2002: ICD-9 diagnosis code V50.41 deleted.
12/19/2003: Code Reference section updated, CPT code 15755, 19362 deleted, ICD-9 diagnosis code range 174.0-174.9, 175.0-175.9 listed separately.
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy.
12/27/2006: Code Reference section updated per the 2007 CPT revisions.
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions.
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied.
9/30/2009: Code reference section updated. Code description revised for ICD-9 diagnosis code 757.6. ICD-9 code 85.7 deleted from covered table due to code deleted as of 9-30-2008.
12/16/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions.
05/06/2013: Policy reviewed; no changes.
08/28/2015: Code Reference section updated for ICD-10. Removed ICD-9 procedure codes 85.36 and 85.41 - 85.48. Removed deleted CPT code 14300.
06/01/2016: Policy number L.7.01.424 added. Policy Guidelines updated to add medically necessary definition.
09/30/2016: Code Reference section updated to add new ICD-10 diagnosis codes N61.0 and N61.1. Added CPT Code 15777, effective 10/01/2016.
10/05/2017: Code Reference section updated to remove deleted ICD-10 diagnosis code N61.
09/30/2019: Code Reference section updated regarding deleted ICD-10 procedure codes.
09/30/2020: Code Reference section updated to add new ICD-10 diagnosis codes N61.20, N61.21, N61.22, and N61.23, effective 10/01/2020. Removed deleted ICD-10 procedure codes 0HRTX7Z, 0HRTXKZ, 0HRUX7Z, 0HRUXKZ, 0HRVX7Z, 0HRVXKZ, 0HRTXJZ, 0HRUXJZ, 0HRVXJZ, 0HUTX7Z, 0HUTXKZ, 0HUTXJZ, 0HUUX7Z, OHUUXJZ, 0HUVX7Z, 0HUVXKZ, 0HUVXJZ, and ICD-9 procedure codes 85.82 and 85.83.
12/17/2020: Code Reference section updated to revise descriptions for CPT codes 11970, 11971, 19318, 19325, 19340, 19342, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, and 19380, effective 01/01/2021.
10/12/2022: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity." Code Reference section updated to remove deleted CPT codes 19324 and 19366.
08/22/2023: Policy reviewed; no changes.
08/29/2024: Policy reviewed; no changes.
10/01/2024: Code Reference section updated to add new ICD-10 procedure codes 0HRT07B, 0HRU07B, and 0HRV07B.
10/01/2025: Code Reference section updated to add new ICD-10 diagnosis codes C50.A0, C50.A1, and C50.A2.
ASPRS Paper
Blue Cross Blue Shield Association policy # 7.01.22
Master Contract
This is may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
Code Number | Description | ||
CPT-4 | |||
00402 | Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum, reconstructive procedures on the breast (eg, reduction or augmentation mammoplasty, muscle flaps) | ||
11920 | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less | ||
11970 | Replacement of tissue expander with permanent implant | ||
11971 | Removal of tissue expander without insertion of implant | ||
14000 | Adjacent tissue transfer or rearrangement, truck; defect 10 sq cm or less | ||
14001 | Adjacent tissue transfer or rearrangement, trunk, defect 10.1 sq cm to 30.0 sq cm | ||
14301 | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm | ||
14302 | Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to primary procedure) | ||
15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | ||
15740 | Flap; island pedicle | ||
15777 | Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) | ||
19316 | Mastopexy | ||
19318 | Breast reduction | ||
19325 | Breast augmentation with implant | ||
19340 | Insertion of breast implant on same day of mastectomy (ie, immediate) | ||
19342 | Insertion or replacement of breast implant on separate day from mastectomy | ||
19350 | Nipple/areola reconstruction | ||
19357 | Tissue expander placement in breast reconstruction, including subsequent expansion(s) | ||
19361 | Breast reconstruction, with latissimus dorsi flap | ||
19364 | Breast reconstruction, with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) | ||
19367 | Breast reconstruction, with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap | ||
19368 | Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging) | ||
19369 | Breast reconstruction, with bipedicled transverse rectus abdominis myocutaneous (TRAM) flap | ||
19370 | Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy | ||
19371 | Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents | ||
19380 | Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction) | ||
19396 | Preparation of moulage for custom breast | ||
HCPCS | |||
L8600 | Implantable breast prosthesis, silicone or equal | ||
S2066 | 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 | ||
S2067 | Breast reconstruction of 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 | ||
S2068 | Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or 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 | ||
ICD-9 Procedure | ICD-10 Procedure | ||
85.35 | Bilateral subcutaneous mammectomy with synchronous implant | 0H0V0JZ, 0H0V3JZ | Alteration of bilateral breast with synthetic substitute, by approach (open or percutaneous) |
85.50 | Augmentation mammoplasty, not otherwise specified | 0H0T07Z, 0H0T0JZ, 0H0T0KZ, 0H0T37Z, 0H0T3JZ, 0H0T3KZ, 0H0U07Z, 0H0U0JZ, 0H0U0KZ, 0H0U37Z, 0H0U3JZ, 0H0U3KZ, 0H0V07Z, 0H0V0JZ, 0H0V0KZ, 0H0V37Z, 0H0V3JZ, 0H0V3KZ | Alteration of breast (right, left, or bilateral) and device (autologous tissue substitute, synthetic substitute, nonautologous tissue substitute) by approach (open or percutaneous) |
85.51 | Unilateral injection into breast for augmentation | 0H0T3JZ, 0H0U3JZ | Alteration of breast (right or left) with synthetic substitute, percutaneous approach |
85.52 | Bilateral injection into breast for augmentation | 0H0V3JZ | Alteration of bilateral breast with nonautologous tissue substitute, percutaneous approach |
85.53 | Unilateral breast implant | 0HUU0JZ, 0HUU3JZ | Supplement left breast with synthetic substitute, by open or percutaneous approach |
0HUU0KZ, 0HUU3KZ | Supplement left breast with nonautologous tissue substitute, by open or percutaneous approach | ||
0HRU0KZ, 0HRU3KZ | Replacement of left breast with nonautologous tissue substitute, by open or percutaneous approach | ||
0HRU0JZ, 0HRU3JZ | Replacement of left breast with synthetic substitute, by open and percutaneous approach | ||
0HUT0JZ, 0HUT3JZ | Supplement right breast with synthetic substitute, by open or percutaneous approach | ||
0HUT0KZ, 0HUT3KZ | Supplement right breast with nonautologous tissue substitute, by open and percutaneous approach | ||
0HRT0JZ, OHRT3JZ | Replacement of right breast with synthetic substitute, by open and percutaneous approach | ||
0HRT0KZ, 0HRT3KZ | Replacement of right breast with nonautologous tissue substitute, by open or percutaneous approach | ||
85.54 | Bilateral breast implant | 0HUV0JZ, 0HUV3JZ | Supplement bilateral breast with synthetic substitute, by approach (open or percutaneous) |
85.6 | Mastopexy | 0HST0ZZ, 0HSU0ZZ, 0HSV0ZZ | Reposition breast (right, left, or bilateral), open approach |
85.70, 85.71, 85.72, 85.73, 85.74, 85.75, 85.76, 85.79 | Total reconstruction of breast code range | 0HRT075, 0HRU075, 0HRV075 | Replacement of breast (right, left, or bilateral) using latissimus dorsi myocutaneous flap, open approach |
0HRT076, 0HRU076, 0HRV076 | Replacement of breast (right, left, or bilateral) using transverse rectus abdominis myocutaneous flap, open approach | ||
0HRT077, 0HRU077, 0HRV077 | Replacement of breast (right, left, or bilateral) using deep inferior epigastric artery perforator flap, open approach | ||
0HRT078, 0HRU078, 0HRV078 | Replacement of breast (right, left, or bilateral) using superficial inferior epigastric artery flap, open approach | ||
0HRT079, 0HRU079, 0HRV079 | Replacement of breast (right, left, or bilateral) using gluteal artery perforator flap, open approach | ||
0HRT07B, 0HRU07B, 0HRV07B | Replacement of breast (right, left, or bilateral) using lumbar artery perforator flap, open approach | ||
0HRT07Z, 0HRT0JZ, 0HRT0KZ, 0HRU07Z, 0HRU0JZ, 0HRU0KZ | Replacement of breast (right or left) with device (autologous tissue substitute, synthetic substitute, or nonautologous tissue substitute) open approach | ||
0KXK0Z6, 0KXL0Z6 | Transfer abdomen muscle (right or left), transverse rectus abdominis myocutaneous flap, open approach | ||
85.84 | Pedicle graft to breast | 0HX5XZZ | Transfer chest skin, external approach |
85.85 | Muscle flap graft to breast | 0KXH0ZZ, 0KXJ0ZZ | Transfer thorax muscle (right or left), open approach |
85.86 | Transposition of nipple | 0HSWXZZ, 0HSXXZZ | Reposition nipple (right or left), external approach |
85.87 | Other repair or reconstruction of nipple | 0HMWXZZ, 0HMXXZZ, | Reattachment of nipple (right or left), external approach |
0HQWXZZ, 0HQXXZZ, | Repair nipple (right or left), external approach | ||
0HRWX7Z, 0HRWXJZ, 0HRWXKZ, 0HRXX7Z, 0HRXXJZ, 0HRXXKZ, | Replacement of nipple (right or left) with device (autologous tissue substitute, synthetic substitute, nonautologous tissue substitute), external approach | ||
0HUWX7Z, 0HUWXJZ, 0HUWXKZ, 0HUXX7Z, 0HUXXJZ, 0HUXXKZ | Supplement nipple (right or left) with device (autologous tissue substitute, synthetic substitute, nonautologous substitute), external approach | ||
85.89 | Other mammoplasty | 0H0T0ZZ, 0H0T3ZZ, 0H0U0ZZ, 0H0U3ZZ, 0H0V0ZZ 0H0V3ZZ | Alteration of breast (right, left, or bilateral), open or percutaneous approach |
0HRT37Z, 0HRT3KZ, 0HRV07Z, 0HRV0KZ, 0HRV37Z, 0HRV3KZ, | Replacement of breast (right, left, or bilateral) with autologous, nonautologous, synthetic tissue substitute, open, percutaneous or external approach | ||
0HUT07Z, 0HUT37Z | Supplement right breast with autologous tissue substitute, open, percutaneous or external approach | ||
0HUU07Z, 0HUU37Z | Supplement left breast with autologous tissue substitute, open, percutaneous or external approach | ||
0HUUXKZ | Supplement left breast with nonautologous tissue substitute, external approach | ||
0HUV07Z, 0HUV0KZ, 0HUV37Z, 0HUV3KZ | Supplement bilateral breast with autologous or nonautologous tissue substitute, open, percutaneous, or external approach | ||
85.93 | Revision of implant of breast | 0HWT0JZ, 0HWT3JZ, 0HWU0JZ, 0HWU3JZ | Revision of synthetic substitute in breast (right or left), by approach (open or percutaneous) |
85.94 | Removal of implant of breast | 0HPT0JZ, 0HPT3JZ, 0HPU0JZ, 0HPU3JZ | Removal of synthetic substitute from breast (right or left), by approach (open or percutaneous) |
85.95 | Insertion of breast tissue expander | 0HHT0NZ, 0HHT3NZ, 0HHU0NZ, 0HHU3NZ, 0HHV0NZ, 0HHV3NZ | Insertion of tissue expander into breast (right, left, or bilateral), by approach (open or percutaneous) |
85.96 | Removal of breast tissue expander (s) | 0HPT0NZ, 0HPT3NZ, 0HPU0NZ, 0HPU3NZ | Removal of tissue expander from breast (right or left), by approach (open or percutaneous) |
86.02 | Injection or tattooing of skin lesion or defect | 3E00XMZ | Introduction of pigment into skin and mucous membranes, external approach |
86.70 | Pedicle or flap graft, not otherwise specified | 0HX6XZZ | Transfer back skin, external approach |
0HX7XZZ | Transfer abdomen skin, external approach | ||
86.71 | Cutting and preparation of pedicle grafts or flaps | 0H85XZZ | Division of chest skin, external approach |
0H86XZZ | Division of back skin, external approach | ||
0H87XZZ | Division of abdomen skin, external approach | ||
86.72 | Advancement of pedicle graft | 0HX5XZZ | Transfer chest skin, external approach |
0HX6XZZ | Transfer back skin, external approach | ||
0HX7XZZ | Transfer abdomen skin, external approach | ||
86.74 | Attachment of pedicle or flap graft to other sites | 0HX5XZZ | Transfer chest skin, external approach |
0HX6XZZ | Transfer back skin, external approach | ||
0HX7XZZ | Transfer abdomen skin, external approach | ||
0JX60ZB | Transfer chest subcutaneous tissue and fascia with skin and subcutaneous tissue, open approach | ||
0JX60ZC | Transfer chest subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, open approach | ||
0JX63ZB | Transfer chest subcutaneous tissue and fascia with skin and subcutaneous tissue, percutaneous approach | ||
0JX63ZC | Transfer chest subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, percutaneous approach | ||
0JX70ZB | Transfer back subcutaneous tissue and fascia with skin and subcutaneous tissue, open approach | ||
0JX70ZC | Transfer back subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, open approach | ||
0JX73ZB | Transfer back subcutaneous tissue and fascia with skin and subcutaneous tissue, percutaneous approach | ||
0JX73ZC | Transfer back subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, percutaneous approach | ||
0JX80ZB | Transfer abdomen subcutaneous tissue and fascia with skin and subcutaneous tissue, open approach | ||
0JX80ZC | Transfer abdomen subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, open approach | ||
0JX83ZB | Transfer abdomen subcutaneous tissue and fascia with skin and subcutaneous tissue, percutaneous approach | ||
0JX83ZC | Transfer abdomen subcutaneous tissue and fascia with skin, subcutaneous tissue and fascia, percutaneous approach | ||
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
172.5 | Malignant melanoma of skin of trunk, except scrotum | C43.52 | Malignant melanoma of skin of breast |
174.0 | Malignant neoplasm of nipple and areola of female breast | C50.011 - C50.019 | Malignant neoplasm of nipple and areola, female (code range) |
174.1 | Malignant neoplasm of central portion of female breast | C50.111 - C50.119 | Malignant neoplasm of central portion of breast, female (code range) |
174.2 | Malignant neoplasm of upper-inner quadrant of female breast | C50.211 - C50.219 | Malignant neoplasm of upper-inner quadrant of breast, female (code range) |
174.3 | Malignant neoplasm of lower-inner quadrant of female breast | C50.311 - C50.319 | Malignant neoplasm of lower-inner quadrant of breast, female (code range) |
174.4 | Malignant neoplasm of upper-outer quadrant of female breast | C50.411 - C50.419 | Malignant neoplasm of upper-outer quadrant breast, female (code range) |
174.5 | Malignant neoplasm of lower-outer quadrant of female breast | C50.511 - C50.519 | Malignant neoplasm of lower-outer quadrant breast, female (code range) |
174.6 | Malignant neoplasm of axillary tail of female breast | C50.611 - C50.619 | Malignant neoplasm of axillary tail of breast, female (code range) |
174.8 | Malignant neoplasm of other specified sites of female breast | C50.811 - C50.819 | Malignant neoplasm of overlapping sites of breast, female (code range) |
174.9 | Malignant neoplasm of breast (female), unspecified site | C50.911 - C50.919 | Malignant neoplasm of breast of unspecified site, female (code range) |
175.0 | Malignant neoplasm of nipple and areola of male breast | C50.021 - C50.029 | Malignant neoplasm of nipple and areola, male (code range) |
175.9 | Malignant neoplasm of other and unspecified sites of male breast | C50.121 - C50.129 | Malignant neoplasm of central portion of breast, male (code range) |
C50.221 - C50.229 | Malignant neoplasm of upper-inner quadrant of breast, male (code range) | ||
C50.321 - C50.329 | Malignant neoplasm of lower-inner quadrant of breast, male (code range) | ||
C50.421 - C50.429 | Malignant neoplasm of upper-outer quadrant breast, male (code range) | ||
C50.521 - C50.529 | Malignant neoplasm of lower-outer quadrant breast, male (code range) | ||
C50.621 - C50.629 | Malignant neoplasm of axillary tail of breast, male (code range) | ||
C50.821 - C50.829 | Malignant neoplasm of overlapping sites of breast, male (code range) | ||
C50.921 - C50.929 | Malignant neoplasm of breast of unspecified site, male (code range) | ||
C50.A0, C50.A1, C50.A2 | Malignant inflammatory neoplasm of breast (New 10/01/2025) | ||
198.2 | Secondary malignant neoplasm of skin | C79.2 | Secondary malignant neoplasm of skin |
198.81 | Secondary malignant neoplasm of breast | C79.81 | Secondary malignant neoplasm of breast |
232.5 | Carcinoma in situ of skin of trunk, except scrotum | D04.5 | Carcinoma in situ of skin of trunk |
233.0 | Carcinoma in situ of breast | D05.00 - D05.92 | Carcinoma in situ of breast (code range) |
610.2 | Fibroadenosis of breast | N60.21- N60.29 | Fibroadenosis of breast (code range) |
610.3 | Fibrosclerosis of breast | N60.31 - N60.39 | Fibrosclerosis of breast (code range) |
611.0 | Inflammatory disease of breast | N61.0, N61.1 | Inflammatory disorders of breast |
N61.20, N61.21, N61.22, N61.23 | Granulomatous mastitis | ||
757.6 | Specified congenital anomalies of breast | Q83.0 - Q83.9 | Congenital malformations of breast (code range) |
942.01 | Burn of trunk, unspecified degree of breast | T21.01XA | Burn of unspecified degree of chest wall, initial encounter |
T21.41XA | Corrosion of unspecified degree of chest wall, initial encounter | ||
942.11 | Erythema due to burn (first degree) of breast | T21.11XA | Burn of first degree of chest wall, initial encounter |
T21.51XA | Corrosion of first degree of chest wall, initial encounter | ||
942.21 | Blisters with epidermal loss due to burn (second degree) of breast | T21.21XA | Burn of second degree of chest wall, initial encounter |
T21.61XA | Corrosion of second degree of chest wall, initial encounter | ||
942.31 | Full-thickness skin loss due to burn (third degree nos) of breast | T21.31XA | Burn of third degree of chest wall, initial encounter |
T21.71XA | Corrosion of third degree of chest wall, initial encounter | ||
942.41 | Deep necrosis of underlying tissues due to burn (deep third degree) of breast, without mention of loss of a body part | T21.31XA | Burn of third degree of chest wall, initial encounter |
T21.71XA | Corrosion of third degree of chest wall, initial encounter | ||
942.51 | Deep necrosis of underlying tissues due to burn (deep third degree) of breast, with loss of a body part | T21.31XA | Burn of third degree of chest wall, initial encounter |
T21.71XA | Corrosion of third degree of chest wall, initial encounter | ||
959.19 | Other injury of other sites of trunk | S39.002A, S39.003A, S39.092A, S39.093A, S39.82XA, S39.83XA, S39.92XA, S39.93XA | Other and unspecified injuries of abdomen, lower back, and pelvis and external genitals |
V51.0 | Encounter for breast reconstruction following mastectomy | Z42.1 | Encounter for breast reconstruction following mastectomy |
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