SUPERSEDED Billing and Coding Article

Billing and Coding: Plastic Surgery

A57221

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Noridian Healthcare Solutions, LLC	A and B MAC	01111 - MAC A	J - E	California - Entire State
Noridian Healthcare Solutions, LLC	A and B MAC	01112 - MAC B	J - E	California - Northern
Noridian Healthcare Solutions, LLC	A and B MAC	01182 - MAC B	J - E	California - Southern
Noridian Healthcare Solutions, LLC	A and B MAC	01211 - MAC A	J - E	American Samoa Guam Hawaii Northern Mariana Islands
Noridian Healthcare Solutions, LLC	A and B MAC	01212 - MAC B	J - E	American Samoa Guam Hawaii Northern Mariana Islands
Noridian Healthcare Solutions, LLC	A and B MAC	01311 - MAC A	J - E	Nevada
Noridian Healthcare Solutions, LLC	A and B MAC	01312 - MAC B	J - E	Nevada
Noridian Healthcare Solutions, LLC	A and B MAC	01911 - MAC A	J - E	American Samoa California - Entire State Guam Hawaii Nevada Northern Mariana Islands

Article Information

General Information

Article ID
A57221

Article Title
Billing and Coding: Plastic Surgery

Article Type
Billing and Coding

Original Effective Date
10/01/2019

Revision Effective Date
01/01/2021

Revision Ending Date
09/30/2023

Retirement Date
N/A

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary.

Title XVIII of the Social Security Act, §1833(e). Prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, §1862(a)(10). Coverage of cosmetic surgery is discussed.

Medicare On-Line Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, §§10, 120, and 180.

Medicare On-Line Manual System, Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §§140.2 and 140.4.

Article Guidance

Article Text

The following coding and billing guidance is to be used with its associated Local coverage determination.

Cosmetic surgery is performed to reshape normal structures of the body, for the purpose of improving the patient’s appearance and self-esteem. Per IOM 100-02 Chapter 16, cosmetic surgery and expenses incurred in connection with such surgery are not covered. This exclusion does not apply to surgery in connection with the treatment of severe burns, facial repair following auto trauma, or similar surgeries for therapeutic purposes or reconstruction.

For Reduction Mammoplasty:
1. Physicians should document the severity of the symptoms of breast hypertrophy and impact on health related quality of life as measured by an accepted breast specific questionnaire.
The beneficiary's medical record must contain the following information and be made available to any authorized Medicare auditor upon request:

Height and weight
Clinical evaluation of the signs and/or symptoms ascribed to the macromastia, therapies prior to reduction mammoplasty and the responses to these therapies.
The operative report with documentation of the weight of tissue removed from each breast, obtained in the operating room.
The pathology report of the tissue removed from each breast.

2. Reasons for denial include:

Surgery is deemed or later determined to be cosmetic in nature. Breast surgery for uncomplicated macromastia, pendulous breasts, or to correct otherwise uncomplicated nipple inversions will be considered cosmetic and not reasonable and necessary.
Failure to clearly document persistent signs and symptoms despite a reasonable trial of conservative therapy for a reasonable length of time.
Services submitted without a listed diagnosis (ICD-10-CM) code supporting medical necessity.
Use of any ICD-10-CM codes not listed in the ICD-10-CM Codes That Support Medical Necessity Section below.

For all procedures noted within this policy:
The medical record must be made available to Medicare or a Medicare auditor upon request.

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Services billed with a diagnosis code that is not listed in the ICD-10-CM Codes That Support Medical Necessity section may be considered at redetermination on a case-by-case basis.

When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services may be denied as not reasonable and necessary.

When requesting a written redetermination, providers must include all relevant documentation with the request. Failure to include such items will likely result in an unfavorable determination. While not required, high quality photographs may be useful in determining medical necessity and may be submitted when the provider feels it is appropriate to do so.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
999x	Not Applicable

Revenue Codes

Code	Description
99999	Not Applicable

CPT/HCPCS Codes

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Group 1

(43 Codes)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
15780	DERMABRASION; TOTAL FACE (EG, FOR ACNE SCARRING, FINE WRINKLING, RHYTIDS, GENERAL KERATOSIS)
15781	DERMABRASION; SEGMENTAL, FACE
15782	DERMABRASION; REGIONAL, OTHER THAN FACE
15783	DERMABRASION; SUPERFICIAL, ANY SITE (EG, TATTOO REMOVAL)
15830	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY
15832	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH
15833	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); LEG
15834	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); HIP
15835	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); BUTTOCK
15836	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ARM
15837	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); FOREARM OR HAND
15838	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); SUBMENTAL FAT PAD
15839	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA
15847	EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY), ABDOMEN (EG, ABDOMINOPLASTY) (INCLUDES UMBILICAL TRANSPOSITION AND FASCIAL PLICATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
15876	SUCTION ASSISTED LIPECTOMY; HEAD AND NECK
15877	SUCTION ASSISTED LIPECTOMY; TRUNK
15878	SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY
15879	SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY
19316	MASTOPEXY
19318	BREAST REDUCTION
19325	BREAST AUGMENTATION WITH IMPLANT
19328	REMOVAL OF INTACT BREAST IMPLANT
19330	REMOVAL OF RUPTURED BREAST IMPLANT, INCLUDING IMPLANT CONTENTS (EG, SALINE, SILICONE GEL)
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
19355	CORRECTION OF INVERTED NIPPLES
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 IMPLANT
30400	RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
30410	RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR CARTILAGES, AND/OR ELEVATION OF NASAL TIP
30420	RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
30430	RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)
30435	RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
30450	RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(387 Codes)

Group 1 Paragraph

Providers are to use the ICD-10-CM® Code that most correctly describes the condition for which any procedure is performed.

These are the only covered ICD-10-CM® codes that support medical necessity:

Dermabrasion (CPT Codes 15780-15783)

Group 1 Codes

Code	Description
L71.0	Perioral dermatitis
L71.1	Rhinophyma
L71.8	Other rosacea
T20.311A	Burn of third degree of right ear [any part, except ear drum], initial encounter
T20.311D	Burn of third degree of right ear [any part, except ear drum], subsequent encounter
T20.311S	Burn of third degree of right ear [any part, except ear drum], sequela
T20.312A	Burn of third degree of left ear [any part, except ear drum], initial encounter
T20.312D	Burn of third degree of left ear [any part, except ear drum], subsequent encounter
T20.312S	Burn of third degree of left ear [any part, except ear drum], sequela
T20.32XA	Burn of third degree of lip(s), initial encounter
T20.32XD	Burn of third degree of lip(s), subsequent encounter
T20.32XS	Burn of third degree of lip(s), sequela
T20.33XA	Burn of third degree of chin, initial encounter
T20.33XD	Burn of third degree of chin, subsequent encounter
T20.33XS	Burn of third degree of chin, sequela
T20.34XA	Burn of third degree of nose (septum), initial encounter
T20.34XD	Burn of third degree of nose (septum), subsequent encounter
T20.34XS	Burn of third degree of nose (septum), sequela
T20.35XA	Burn of third degree of scalp [any part], initial encounter
T20.35XD	Burn of third degree of scalp [any part], subsequent encounter
T20.35XS	Burn of third degree of scalp [any part], sequela
T20.36XA	Burn of third degree of forehead and cheek, initial encounter
T20.36XD	Burn of third degree of forehead and cheek, subsequent encounter
T20.36XS	Burn of third degree of forehead and cheek, sequela
T20.37XA	Burn of third degree of neck, initial encounter
T20.37XD	Burn of third degree of neck, subsequent encounter
T20.37XS	Burn of third degree of neck, sequela
T20.39XA	Burn of third degree of multiple sites of head, face, and neck, initial encounter
T20.39XD	Burn of third degree of multiple sites of head, face, and neck, subsequent encounter
T20.39XS	Burn of third degree of multiple sites of head, face, and neck, sequela
T20.711A	Corrosion of third degree of right ear [any part, except ear drum], initial encounter
T20.711D	Corrosion of third degree of right ear [any part, except ear drum], subsequent encounter
T20.711S	Corrosion of third degree of right ear [any part, except ear drum], sequela
T20.712A	Corrosion of third degree of left ear [any part, except ear drum], initial encounter
T20.712D	Corrosion of third degree of left ear [any part, except ear drum], subsequent encounter
T20.712S	Corrosion of third degree of left ear [any part, except ear drum], sequela
T20.72XA	Corrosion of third degree of lip(s), initial encounter
T20.72XD	Corrosion of third degree of lip(s), subsequent encounter
T20.72XS	Corrosion of third degree of lip(s), sequela
T20.73XA	Corrosion of third degree of chin, initial encounter
T20.73XD	Corrosion of third degree of chin, subsequent encounter
T20.73XS	Corrosion of third degree of chin, sequela
T20.74XA	Corrosion of third degree of nose (septum), initial encounter
T20.74XD	Corrosion of third degree of nose (septum), subsequent encounter
T20.74XS	Corrosion of third degree of nose (septum), sequela
T20.75XA	Corrosion of third degree of scalp [any part], initial encounter
T20.75XD	Corrosion of third degree of scalp [any part], subsequent encounter
T20.75XS	Corrosion of third degree of scalp [any part], sequela
T20.76XA	Corrosion of third degree of forehead and cheek, initial encounter
T20.76XD	Corrosion of third degree of forehead and cheek, subsequent encounter
T20.76XS	Corrosion of third degree of forehead and cheek, sequela
T20.77XA	Corrosion of third degree of neck, initial encounter
T20.77XD	Corrosion of third degree of neck, subsequent encounter
T20.77XS	Corrosion of third degree of neck, sequela
T20.79XA	Corrosion of third degree of multiple sites of head, face, and neck, initial encounter
T20.79XD	Corrosion of third degree of multiple sites of head, face, and neck, subsequent encounter
T20.79XS	Corrosion of third degree of multiple sites of head, face, and neck, sequela
T21.31XA	Burn of third degree of chest wall, initial encounter
T21.31XD	Burn of third degree of chest wall, subsequent encounter
T21.31XS	Burn of third degree of chest wall, sequela
T21.32XA	Burn of third degree of abdominal wall, initial encounter
T21.32XD	Burn of third degree of abdominal wall, subsequent encounter
T21.32XS	Burn of third degree of abdominal wall, sequela
T21.33XA	Burn of third degree of upper back, initial encounter
T21.33XD	Burn of third degree of upper back, subsequent encounter
T21.33XS	Burn of third degree of upper back, sequela
T21.34XA	Burn of third degree of lower back, initial encounter
T21.34XD	Burn of third degree of lower back, subsequent encounter
T21.34XS	Burn of third degree of lower back, sequela
T21.35XA	Burn of third degree of buttock, initial encounter
T21.35XD	Burn of third degree of buttock, subsequent encounter
T21.35XS	Burn of third degree of buttock, sequela
T21.36XA	Burn of third degree of male genital region, initial encounter
T21.36XD	Burn of third degree of male genital region, subsequent encounter
T21.36XS	Burn of third degree of male genital region, sequela
T21.37XA	Burn of third degree of female genital region, initial encounter
T21.37XD	Burn of third degree of female genital region, subsequent encounter
T21.37XS	Burn of third degree of female genital region, sequela
T21.39XA	Burn of third degree of other site of trunk, initial encounter
T21.39XD	Burn of third degree of other site of trunk, subsequent encounter
T21.39XS	Burn of third degree of other site of trunk, sequela
T21.71XA	Corrosion of third degree of chest wall, initial encounter
T21.71XD	Corrosion of third degree of chest wall, subsequent encounter
T21.71XS	Corrosion of third degree of chest wall, sequela
T21.72XA	Corrosion of third degree of abdominal wall, initial encounter
T21.72XD	Corrosion of third degree of abdominal wall, subsequent encounter
T21.72XS	Corrosion of third degree of abdominal wall, sequela
T21.73XA	Corrosion of third degree of upper back, initial encounter
T21.73XD	Corrosion of third degree of upper back, subsequent encounter
T21.73XS	Corrosion of third degree of upper back, sequela
T21.74XA	Corrosion of third degree of lower back, initial encounter
T21.74XD	Corrosion of third degree of lower back, subsequent encounter
T21.74XS	Corrosion of third degree of lower back, sequela
T21.75XA	Corrosion of third degree of buttock, initial encounter
T21.75XD	Corrosion of third degree of buttock, subsequent encounter
T21.75XS	Corrosion of third degree of buttock, sequela
T21.76XA	Corrosion of third degree of male genital region, initial encounter
T21.76XD	Corrosion of third degree of male genital region, subsequent encounter
T21.76XS	Corrosion of third degree of male genital region, sequela
T21.77XA	Corrosion of third degree of female genital region, initial encounter
T21.77XD	Corrosion of third degree of female genital region, subsequent encounter
T21.77XS	Corrosion of third degree of female genital region, sequela
T21.79XA	Corrosion of third degree of other site of trunk, initial encounter
T21.79XD	Corrosion of third degree of other site of trunk, subsequent encounter
T21.79XS	Corrosion of third degree of other site of trunk, sequela
T22.311A	Burn of third degree of right forearm, initial encounter
T22.311D	Burn of third degree of right forearm, subsequent encounter
T22.311S	Burn of third degree of right forearm, sequela
T22.312A	Burn of third degree of left forearm, initial encounter
T22.312D	Burn of third degree of left forearm, subsequent encounter
T22.312S	Burn of third degree of left forearm, sequela
T22.321A	Burn of third degree of right elbow, initial encounter
T22.321D	Burn of third degree of right elbow, subsequent encounter
T22.321S	Burn of third degree of right elbow, sequela
T22.322A	Burn of third degree of left elbow, initial encounter
T22.322D	Burn of third degree of left elbow, subsequent encounter
T22.322S	Burn of third degree of left elbow, sequela
T22.331A	Burn of third degree of right upper arm, initial encounter
T22.331D	Burn of third degree of right upper arm, subsequent encounter
T22.331S	Burn of third degree of right upper arm, sequela
T22.332A	Burn of third degree of left upper arm, initial encounter
T22.332D	Burn of third degree of left upper arm, subsequent encounter
T22.332S	Burn of third degree of left upper arm, sequela
T22.341A	Burn of third degree of right axilla, initial encounter
T22.341D	Burn of third degree of right axilla, subsequent encounter
T22.341S	Burn of third degree of right axilla, sequela
T22.342A	Burn of third degree of left axilla, initial encounter
T22.342D	Burn of third degree of left axilla, subsequent encounter
T22.342S	Burn of third degree of left axilla, sequela
T22.351A	Burn of third degree of right shoulder, initial encounter
T22.351D	Burn of third degree of right shoulder, subsequent encounter
T22.351S	Burn of third degree of right shoulder, sequela
T22.352A	Burn of third degree of left shoulder, initial encounter
T22.352D	Burn of third degree of left shoulder, subsequent encounter
T22.352S	Burn of third degree of left shoulder, sequela
T22.361A	Burn of third degree of right scapular region, initial encounter
T22.361D	Burn of third degree of right scapular region, subsequent encounter
T22.361S	Burn of third degree of right scapular region, sequela
T22.362A	Burn of third degree of left scapular region, initial encounter
T22.362D	Burn of third degree of left scapular region, subsequent encounter
T22.362S	Burn of third degree of left scapular region, sequela
T22.391A	Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, initial encounter
T22.391D	Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, subsequent encounter
T22.391S	Burn of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, sequela
T22.392A	Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, initial encounter
T22.392D	Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, subsequent encounter
T22.392S	Burn of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, sequela
T22.711A	Corrosion of third degree of right forearm, initial encounter
T22.711D	Corrosion of third degree of right forearm, subsequent encounter
T22.711S	Corrosion of third degree of right forearm, sequela
T22.712A	Corrosion of third degree of left forearm, initial encounter
T22.712D	Corrosion of third degree of left forearm, subsequent encounter
T22.712S	Corrosion of third degree of left forearm, sequela
T22.721A	Corrosion of third degree of right elbow, initial encounter
T22.721D	Corrosion of third degree of right elbow, subsequent encounter
T22.721S	Corrosion of third degree of right elbow, sequela
T22.722A	Corrosion of third degree of left elbow, initial encounter
T22.722D	Corrosion of third degree of left elbow, subsequent encounter
T22.722S	Corrosion of third degree of left elbow, sequela
T22.731A	Corrosion of third degree of right upper arm, initial encounter
T22.731D	Corrosion of third degree of right upper arm, subsequent encounter
T22.731S	Corrosion of third degree of right upper arm, sequela
T22.732A	Corrosion of third degree of left upper arm, initial encounter
T22.732D	Corrosion of third degree of left upper arm, subsequent encounter
T22.732S	Corrosion of third degree of left upper arm, sequela
T22.741A	Corrosion of third degree of right axilla, initial encounter
T22.741D	Corrosion of third degree of right axilla, subsequent encounter
T22.741S	Corrosion of third degree of right axilla, sequela
T22.742A	Corrosion of third degree of left axilla, initial encounter
T22.742D	Corrosion of third degree of left axilla, subsequent encounter
T22.742S	Corrosion of third degree of left axilla, sequela
T22.751A	Corrosion of third degree of right shoulder, initial encounter
T22.751D	Corrosion of third degree of right shoulder, subsequent encounter
T22.751S	Corrosion of third degree of right shoulder, sequela
T22.752A	Corrosion of third degree of left shoulder, initial encounter
T22.752D	Corrosion of third degree of left shoulder, subsequent encounter
T22.752S	Corrosion of third degree of left shoulder, sequela
T22.761A	Corrosion of third degree of right scapular region, initial encounter
T22.761D	Corrosion of third degree of right scapular region, subsequent encounter
T22.761S	Corrosion of third degree of right scapular region, sequela
T22.762A	Corrosion of third degree of left scapular region, initial encounter
T22.762D	Corrosion of third degree of left scapular region, subsequent encounter
T22.762S	Corrosion of third degree of left scapular region, sequela
T22.791A	Corrosion of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, initial encounter
T22.791D	Corrosion of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, subsequent encounter
T22.791S	Corrosion of third degree of multiple sites of right shoulder and upper limb, except wrist and hand, sequela
T22.792A	Corrosion of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, initial encounter
T22.792D	Corrosion of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, subsequent encounter
T22.792S	Corrosion of third degree of multiple sites of left shoulder and upper limb, except wrist and hand, sequela
T23.311A	Burn of third degree of right thumb (nail), initial encounter
T23.311D	Burn of third degree of right thumb (nail), subsequent encounter
T23.311S	Burn of third degree of right thumb (nail), sequela
T23.312A	Burn of third degree of left thumb (nail), initial encounter
T23.312D	Burn of third degree of left thumb (nail), subsequent encounter
T23.312S	Burn of third degree of left thumb (nail), sequela
T23.321A	Burn of third degree of single right finger (nail) except thumb, initial encounter
T23.321D	Burn of third degree of single right finger (nail) except thumb, subsequent encounter
T23.321S	Burn of third degree of single right finger (nail) except thumb, sequela
T23.322A	Burn of third degree of single left finger (nail) except thumb, initial encounter
T23.322D	Burn of third degree of single left finger (nail) except thumb, subsequent encounter
T23.322S	Burn of third degree of single left finger (nail) except thumb, sequela
T23.331A	Burn of third degree of multiple right fingers (nail), not including thumb, initial encounter
T23.331D	Burn of third degree of multiple right fingers (nail), not including thumb, subsequent encounter
T23.331S	Burn of third degree of multiple right fingers (nail), not including thumb, sequela
T23.332A	Burn of third degree of multiple left fingers (nail), not including thumb, initial encounter
T23.332D	Burn of third degree of multiple left fingers (nail), not including thumb, subsequent encounter
T23.332S	Burn of third degree of multiple left fingers (nail), not including thumb, sequela
T23.341A	Burn of third degree of multiple right fingers (nail), including thumb, initial encounter
T23.341D	Burn of third degree of multiple right fingers (nail), including thumb, subsequent encounter
T23.341S	Burn of third degree of multiple right fingers (nail), including thumb, sequela
T23.342A	Burn of third degree of multiple left fingers (nail), including thumb, initial encounter
T23.342D	Burn of third degree of multiple left fingers (nail), including thumb, subsequent encounter
T23.342S	Burn of third degree of multiple left fingers (nail), including thumb, sequela
T23.351A	Burn of third degree of right palm, initial encounter
T23.351D	Burn of third degree of right palm, subsequent encounter
T23.351S	Burn of third degree of right palm, sequela
T23.352A	Burn of third degree of left palm, initial encounter
T23.352D	Burn of third degree of left palm, subsequent encounter
T23.352S	Burn of third degree of left palm, sequela
T23.361A	Burn of third degree of back of right hand, initial encounter
T23.361D	Burn of third degree of back of right hand, subsequent encounter
T23.361S	Burn of third degree of back of right hand, sequela
T23.362A	Burn of third degree of back of left hand, initial encounter
T23.362D	Burn of third degree of back of left hand, subsequent encounter
T23.362S	Burn of third degree of back of left hand, sequela
T23.371A	Burn of third degree of right wrist, initial encounter
T23.371D	Burn of third degree of right wrist, subsequent encounter
T23.371S	Burn of third degree of right wrist, sequela
T23.372A	Burn of third degree of left wrist, initial encounter
T23.372D	Burn of third degree of left wrist, subsequent encounter
T23.372S	Burn of third degree of left wrist, sequela
T23.391A	Burn of third degree of multiple sites of right wrist and hand, initial encounter
T23.391D	Burn of third degree of multiple sites of right wrist and hand, subsequent encounter
T23.391S	Burn of third degree of multiple sites of right wrist and hand, sequela
T23.392A	Burn of third degree of multiple sites of left wrist and hand, initial encounter
T23.392D	Burn of third degree of multiple sites of left wrist and hand, subsequent encounter
T23.392S	Burn of third degree of multiple sites of left wrist and hand, sequela
T23.711A	Corrosion of third degree of right thumb (nail), initial encounter
T23.711D	Corrosion of third degree of right thumb (nail), subsequent encounter
T23.711S	Corrosion of third degree of right thumb (nail), sequela
T23.712A	Corrosion of third degree of left thumb (nail), initial encounter
T23.712D	Corrosion of third degree of left thumb (nail), subsequent encounter
T23.712S	Corrosion of third degree of left thumb (nail), sequela
T23.721A	Corrosion of third degree of single right finger (nail) except thumb, initial encounter
T23.721D	Corrosion of third degree of single right finger (nail) except thumb, subsequent encounter
T23.721S	Corrosion of third degree of single right finger (nail) except thumb, sequela
T23.722A	Corrosion of third degree of single left finger (nail) except thumb, initial encounter
T23.722D	Corrosion of third degree of single left finger (nail) except thumb, subsequent encounter
T23.722S	Corrosion of third degree of single left finger (nail) except thumb, sequela
T23.731A	Corrosion of third degree of multiple right fingers (nail), not including thumb, initial encounter
T23.731D	Corrosion of third degree of multiple right fingers (nail), not including thumb, subsequent encounter
T23.731S	Corrosion of third degree of multiple right fingers (nail), not including thumb, sequela
T23.732A	Corrosion of third degree of multiple left fingers (nail), not including thumb, initial encounter
T23.732D	Corrosion of third degree of multiple left fingers (nail), not including thumb, subsequent encounter
T23.732S	Corrosion of third degree of multiple left fingers (nail), not including thumb, sequela
T23.741A	Corrosion of third degree of multiple right fingers (nail), including thumb, initial encounter
T23.741D	Corrosion of third degree of multiple right fingers (nail), including thumb, subsequent encounter
T23.741S	Corrosion of third degree of multiple right fingers (nail), including thumb, sequela
T23.742A	Corrosion of third degree of multiple left fingers (nail), including thumb, initial encounter
T23.742D	Corrosion of third degree of multiple left fingers (nail), including thumb, subsequent encounter
T23.742S	Corrosion of third degree of multiple left fingers (nail), including thumb, sequela
T23.751A	Corrosion of third degree of right palm, initial encounter
T23.751D	Corrosion of third degree of right palm, subsequent encounter
T23.751S	Corrosion of third degree of right palm, sequela
T23.752A	Corrosion of third degree of left palm, initial encounter
T23.752D	Corrosion of third degree of left palm, subsequent encounter
T23.752S	Corrosion of third degree of left palm, sequela
T23.761A	Corrosion of third degree of back of right hand, initial encounter
T23.761D	Corrosion of third degree of back of right hand, subsequent encounter
T23.761S	Corrosion of third degree of back of right hand, sequela
T23.762A	Corrosion of third degree of back of left hand, initial encounter
T23.762D	Corrosion of third degree of back of left hand, subsequent encounter
T23.762S	Corrosion of third degree of back of left hand, sequela
T23.771A	Corrosion of third degree of right wrist, initial encounter
T23.771D	Corrosion of third degree of right wrist, subsequent encounter
T23.771S	Corrosion of third degree of right wrist, sequela
T23.772A	Corrosion of third degree of left wrist, initial encounter
T23.772D	Corrosion of third degree of left wrist, subsequent encounter
T23.772S	Corrosion of third degree of left wrist, sequela
T23.791A	Corrosion of third degree of multiple sites of right wrist and hand, initial encounter
T23.791D	Corrosion of third degree of multiple sites of right wrist and hand, subsequent encounter
T23.791S	Corrosion of third degree of multiple sites of right wrist and hand, sequela
T23.792A	Corrosion of third degree of multiple sites of left wrist and hand, initial encounter
T23.792D	Corrosion of third degree of multiple sites of left wrist and hand, subsequent encounter
T23.792S	Corrosion of third degree of multiple sites of left wrist and hand, sequela
T24.311A	Burn of third degree of right thigh, initial encounter
T24.311D	Burn of third degree of right thigh, subsequent encounter
T24.311S	Burn of third degree of right thigh, sequela
T24.312A	Burn of third degree of left thigh, initial encounter
T24.312D	Burn of third degree of left thigh, subsequent encounter
T24.312S	Burn of third degree of left thigh, sequela
T24.321A	Burn of third degree of right knee, initial encounter
T24.321D	Burn of third degree of right knee, subsequent encounter
T24.321S	Burn of third degree of right knee, sequela
T24.322A	Burn of third degree of left knee, initial encounter
T24.322D	Burn of third degree of left knee, subsequent encounter
T24.322S	Burn of third degree of left knee, sequela
T24.331A	Burn of third degree of right lower leg, initial encounter
T24.331D	Burn of third degree of right lower leg, subsequent encounter
T24.331S	Burn of third degree of right lower leg, sequela
T24.332A	Burn of third degree of left lower leg, initial encounter
T24.332D	Burn of third degree of left lower leg, subsequent encounter
T24.332S	Burn of third degree of left lower leg, sequela
T24.391A	Burn of third degree of multiple sites of right lower limb, except ankle and foot, initial encounter
T24.391D	Burn of third degree of multiple sites of right lower limb, except ankle and foot, subsequent encounter
T24.391S	Burn of third degree of multiple sites of right lower limb, except ankle and foot, sequela
T24.392A	Burn of third degree of multiple sites of left lower limb, except ankle and foot, initial encounter
T24.392D	Burn of third degree of multiple sites of left lower limb, except ankle and foot, subsequent encounter
T24.392S	Burn of third degree of multiple sites of left lower limb, except ankle and foot, sequela
T24.711A	Corrosion of third degree of right thigh, initial encounter
T24.711D	Corrosion of third degree of right thigh, subsequent encounter
T24.711S	Corrosion of third degree of right thigh, sequela
T24.712A	Corrosion of third degree of left thigh, initial encounter
T24.712D	Corrosion of third degree of left thigh, subsequent encounter
T24.712S	Corrosion of third degree of left thigh, sequela
T24.721A	Corrosion of third degree of right knee, initial encounter
T24.721D	Corrosion of third degree of right knee, subsequent encounter
T24.721S	Corrosion of third degree of right knee, sequela
T24.722A	Corrosion of third degree of left knee, initial encounter
T24.722D	Corrosion of third degree of left knee, subsequent encounter
T24.722S	Corrosion of third degree of left knee, sequela
T24.731A	Corrosion of third degree of right lower leg, initial encounter
T24.731D	Corrosion of third degree of right lower leg, subsequent encounter
T24.731S	Corrosion of third degree of right lower leg, sequela
T24.732A	Corrosion of third degree of left lower leg, initial encounter
T24.732D	Corrosion of third degree of left lower leg, subsequent encounter
T24.732S	Corrosion of third degree of left lower leg, sequela
T24.791A	Corrosion of third degree of multiple sites of right lower limb, except ankle and foot, initial encounter
T24.791D	Corrosion of third degree of multiple sites of right lower limb, except ankle and foot, subsequent encounter
T24.791S	Corrosion of third degree of multiple sites of right lower limb, except ankle and foot, sequela
T24.792A	Corrosion of third degree of multiple sites of left lower limb, except ankle and foot, initial encounter
T24.792D	Corrosion of third degree of multiple sites of left lower limb, except ankle and foot, subsequent encounter
T24.792S	Corrosion of third degree of multiple sites of left lower limb, except ankle and foot, sequela
T25.311A	Burn of third degree of right ankle, initial encounter
T25.311D	Burn of third degree of right ankle, subsequent encounter
T25.311S	Burn of third degree of right ankle, sequela
T25.312A	Burn of third degree of left ankle, initial encounter
T25.312D	Burn of third degree of left ankle, subsequent encounter
T25.312S	Burn of third degree of left ankle, sequela
T25.321A	Burn of third degree of right foot, initial encounter
T25.321D	Burn of third degree of right foot, subsequent encounter
T25.321S	Burn of third degree of right foot, sequela
T25.322A	Burn of third degree of left foot, initial encounter
T25.322D	Burn of third degree of left foot, subsequent encounter
T25.322S	Burn of third degree of left foot, sequela
T25.331A	Burn of third degree of right toe(s) (nail), initial encounter
T25.331D	Burn of third degree of right toe(s) (nail), subsequent encounter
T25.331S	Burn of third degree of right toe(s) (nail), sequela
T25.332A	Burn of third degree of left toe(s) (nail), initial encounter
T25.332D	Burn of third degree of left toe(s) (nail), subsequent encounter
T25.332S	Burn of third degree of left toe(s) (nail), sequela
T25.391A	Burn of third degree of multiple sites of right ankle and foot, initial encounter
T25.391D	Burn of third degree of multiple sites of right ankle and foot, subsequent encounter
T25.391S	Burn of third degree of multiple sites of right ankle and foot, sequela
T25.392A	Burn of third degree of multiple sites of left ankle and foot, initial encounter
T25.392D	Burn of third degree of multiple sites of left ankle and foot, subsequent encounter
T25.392S	Burn of third degree of multiple sites of left ankle and foot, sequela
T25.711A	Corrosion of third degree of right ankle, initial encounter
T25.711D	Corrosion of third degree of right ankle, subsequent encounter
T25.711S	Corrosion of third degree of right ankle, sequela
T25.712A	Corrosion of third degree of left ankle, initial encounter
T25.712D	Corrosion of third degree of left ankle, subsequent encounter
T25.712S	Corrosion of third degree of left ankle, sequela
T25.721A	Corrosion of third degree of right foot, initial encounter
T25.721D	Corrosion of third degree of right foot, subsequent encounter
T25.721S	Corrosion of third degree of right foot, sequela
T25.722A	Corrosion of third degree of left foot, initial encounter
T25.722D	Corrosion of third degree of left foot, subsequent encounter
T25.722S	Corrosion of third degree of left foot, sequela
T25.731A	Corrosion of third degree of right toe(s) (nail), initial encounter
T25.731D	Corrosion of third degree of right toe(s) (nail), subsequent encounter
T25.731S	Corrosion of third degree of right toe(s) (nail), sequela
T25.732A	Corrosion of third degree of left toe(s) (nail), initial encounter
T25.732D	Corrosion of third degree of left toe(s) (nail), subsequent encounter
T25.732S	Corrosion of third degree of left toe(s) (nail), sequela
T25.791A	Corrosion of third degree of multiple sites of right ankle and foot, initial encounter
T25.791D	Corrosion of third degree of multiple sites of right ankle and foot, subsequent encounter
T25.791S	Corrosion of third degree of multiple sites of right ankle and foot, sequela
T25.792A	Corrosion of third degree of multiple sites of left ankle and foot, initial encounter
T25.792D	Corrosion of third degree of multiple sites of left ankle and foot, subsequent encounter
T25.792S	Corrosion of third degree of multiple sites of left ankle and foot, sequela
T26.21XA	Burn with resulting rupture and destruction of right eyeball, initial encounter
T26.21XD	Burn with resulting rupture and destruction of right eyeball, subsequent encounter
T26.21XS	Burn with resulting rupture and destruction of right eyeball, sequela
T26.22XA	Burn with resulting rupture and destruction of left eyeball, initial encounter
T26.22XD	Burn with resulting rupture and destruction of left eyeball, subsequent encounter
T26.22XS	Burn with resulting rupture and destruction of left eyeball, sequela

Group 2

(65 Codes)

Group 2 Paragraph

Abdominal Lipectomy/Panniculectomy (CPT Codes 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839 and 15847)

Group 2 Codes

Code	Description
A31.1	Cutaneous mycobacterial infection
A43.1	Cutaneous nocardiosis
A46	Erysipelas
A48.0	Gas gangrene
B35.6	Tinea cruris
B35.8	Other dermatophytoses
B37.2	Candidiasis of skin and nail
B95.0	Streptococcus, group A, as the cause of diseases classified elsewhere
B95.1	Streptococcus, group B, as the cause of diseases classified elsewhere
B95.2	Enterococcus as the cause of diseases classified elsewhere
B95.3	Streptococcus pneumoniae as the cause of diseases classified elsewhere
B95.4	Other streptococcus as the cause of diseases classified elsewhere
B95.61	Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.62	Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.7	Other staphylococcus as the cause of diseases classified elsewhere
B96.0	Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere
B96.1	Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere
B96.3	Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere
B96.4	Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere
B96.5	Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere
B96.6	Bacteroides fragilis [B. fragilis] as the cause of diseases classified elsewhere
B96.7	Clostridium perfringens [C. perfringens] as the cause of diseases classified elsewhere
B96.81	Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
B96.82	Vibrio vulnificus as the cause of diseases classified elsewhere
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
I70.231	Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.238	Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241	Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.248	Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.25	Atherosclerosis of native arteries of other extremities with ulceration
I70.431	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.441	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.45	Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration
I70.531	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.541	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.55	Atherosclerosis of nonautologous biological bypass graft(s) of other extremity with ulceration
I70.631	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.641	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.65	Atherosclerosis of nonbiological bypass graft(s) of other extremity with ulceration
I70.731	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.741	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.75	Atherosclerosis of other type of bypass graft(s) of other extremity with ulceration
L03.311	Cellulitis of abdominal wall
L08.1	Erythrasma
L30.4	Erythema intertrigo
L97.111	Non-pressure chronic ulcer of right thigh limited to breakdown of skin
L97.112	Non-pressure chronic ulcer of right thigh with fat layer exposed
L97.113	Non-pressure chronic ulcer of right thigh with necrosis of muscle
L97.114	Non-pressure chronic ulcer of right thigh with necrosis of bone
L97.121	Non-pressure chronic ulcer of left thigh limited to breakdown of skin
L97.122	Non-pressure chronic ulcer of left thigh with fat layer exposed
L97.123	Non-pressure chronic ulcer of left thigh with necrosis of muscle
L97.124	Non-pressure chronic ulcer of left thigh with necrosis of bone
L98.411	Non-pressure chronic ulcer of buttock limited to breakdown of skin
L98.412	Non-pressure chronic ulcer of buttock with fat layer exposed
L98.413	Non-pressure chronic ulcer of buttock with necrosis of muscle
L98.414	Non-pressure chronic ulcer of buttock with necrosis of bone
L98.421	Non-pressure chronic ulcer of back limited to breakdown of skin
L98.422	Non-pressure chronic ulcer of back with fat layer exposed
L98.423	Non-pressure chronic ulcer of back with necrosis of muscle
L98.424	Non-pressure chronic ulcer of back with necrosis of bone
L98.491	Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin
L98.492	Non-pressure chronic ulcer of skin of other sites with fat layer exposed
L98.493	Non-pressure chronic ulcer of skin of other sites with necrosis of muscle
L98.494	Non-pressure chronic ulcer of skin of other sites with necrosis of bone

Group 3

(71 Codes)

Group 3 Paragraph

Reconstructive Breast Surgery (CPT Codes 19316,19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396)

Group 3 Codes

Code	Description
C50.011	Malignant neoplasm of nipple and areola, right female breast
C50.012	Malignant neoplasm of nipple and areola, left female breast
C50.021	Malignant neoplasm of nipple and areola, right male breast
C50.022	Malignant neoplasm of nipple and areola, left male breast
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.221	Malignant neoplasm of upper-inner quadrant of right male breast
C50.222	Malignant neoplasm of upper-inner quadrant of left male breast
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.321	Malignant neoplasm of lower-inner quadrant of right male breast
C50.322	Malignant neoplasm of lower-inner quadrant of left male breast
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast
C50.421	Malignant neoplasm of upper-outer quadrant of right male breast
C50.422	Malignant neoplasm of upper-outer quadrant of left male breast
C50.511	Malignant neoplasm of lower-outer quadrant of right female breast
C50.512	Malignant neoplasm of lower-outer quadrant of left female breast
C50.521	Malignant neoplasm of lower-outer quadrant of right male breast
C50.522	Malignant neoplasm of lower-outer quadrant of left male breast
C50.611	Malignant neoplasm of axillary tail of right female breast
C50.612	Malignant neoplasm of axillary tail of left female breast
C50.621	Malignant neoplasm of axillary tail of right male breast
C50.622	Malignant neoplasm of axillary tail of left male breast
C50.811	Malignant neoplasm of overlapping sites of right female breast
C50.812	Malignant neoplasm of overlapping sites of left female breast
C50.821	Malignant neoplasm of overlapping sites of right male breast
C50.822	Malignant neoplasm of overlapping sites of left male breast
C79.2	Secondary malignant neoplasm of skin
C79.81	Secondary malignant neoplasm of breast
D04.5	Carcinoma in situ of skin of trunk
D05.01	Lobular carcinoma in situ of right breast
D05.02	Lobular carcinoma in situ of left breast
D05.11	Intraductal carcinoma in situ of right breast
D05.12	Intraductal carcinoma in situ of left breast
D05.81	Other specified type of carcinoma in situ of right breast
D05.82	Other specified type of carcinoma in situ of left breast
D24.1	Benign neoplasm of right breast
D24.2	Benign neoplasm of left breast
D48.61	Neoplasm of uncertain behavior of right breast
D48.62	Neoplasm of uncertain behavior of left breast
N65.0	Deformity of reconstructed breast
N65.1	Disproportion of reconstructed breast
T85.41XA	Breakdown (mechanical) of breast prosthesis and implant, initial encounter
T85.41XD	Breakdown (mechanical) of breast prosthesis and implant, subsequent encounter
T85.41XS	Breakdown (mechanical) of breast prosthesis and implant, sequela
T85.42XA	Displacement of breast prosthesis and implant, initial encounter
T85.42XD	Displacement of breast prosthesis and implant, subsequent encounter
T85.42XS	Displacement of breast prosthesis and implant, sequela
T85.43XA	Leakage of breast prosthesis and implant, initial encounter
T85.43XD	Leakage of breast prosthesis and implant, subsequent encounter
T85.43XS	Leakage of breast prosthesis and implant, sequela
T85.44XA	Capsular contracture of breast implant, initial encounter
T85.44XD	Capsular contracture of breast implant, subsequent encounter
T85.44XS	Capsular contracture of breast implant, sequela
T85.49XA	Other mechanical complication of breast prosthesis and implant, initial encounter
T85.49XD	Other mechanical complication of breast prosthesis and implant, subsequent encounter
T85.49XS	Other mechanical complication of breast prosthesis and implant, sequela
T85.79XA	Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter
T85.79XD	Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, subsequent encounter
T85.79XS	Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, sequela
Z42.1	Encounter for breast reconstruction following mastectomy
Z45.811	Encounter for adjustment or removal of right breast implant
Z45.812	Encounter for adjustment or removal of left breast implant
Z48.3	Aftercare following surgery for neoplasm
Z85.3	Personal history of malignant neoplasm of breast
Z98.82	Breast implant status

Group 4

(2 Codes)

Group 4 Paragraph

Reduction Mammoplasty (CPT Code 19318)

Three diagnoses are required for payment (One primary and two secondary).

Primary ICD-10-CM:

Group 4 Codes

Code	Description
N62*	Hypertrophy of breast
N65.1*	Disproportion of reconstructed breast

Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Primary diagnosis N62 must be billed with two of the secondary diagnoses: listed in Group 5 Secondary Codes for Reduction Mammaplasty. When billing for surgery on the unaffected breast to restore symmetry following breast cancer surgery on the contralateral breast, N65.1 must be used as the primary diagnosis with one of the C50.XXX ICD-10 codes as a secondary diagnosis.

C50.XXX Codes:

C50.011
C50.012
C50.021
C50.022
C50.111
C50.112
C50.121
C50.122
C50.211
C50.212
C50.221
C50.222
C50.311
C50.312
C50.321
C50.322
C50.411
C50.412
C50.421
C50.422
C50.511
C50.512
C50.521
C50.522
C50.611
C50.612
C50.621
C50.622
C50.811
C50.812
C50.821
C50.822

Group 5

(23 Codes)

Group 5 Paragraph

Secondary ICD-10-CMs to be used when billing one of the reduction mammaplasty primary codes. Correct coding for this procedure requires two secondary ICD-10-CM codes from Group 5 (this section) and one of the primary ICD-10-CM codes from Group 4.

Group 5 Codes

Code	Description
L26*	Exfoliative dermatitis
L30.4*	Erythema intertrigo
L53.8*	Other specified erythematous conditions
L54*	Erythema in diseases classified elsewhere
L92.0*	Granuloma annulare
L95.1*	Erythema elevatum diutinum
L98.2*	Febrile neutrophilic dermatosis [Sweet]
M25.511*	Pain in right shoulder
M25.512*	Pain in left shoulder
M40.04	Postural kyphosis, thoracic region
M53.81	Other specified dorsopathies, occipito-atlanto-axial region
M53.82	Other specified dorsopathies, cervical region
M53.83	Other specified dorsopathies, cervicothoracic region
M53.84	Other specified dorsopathies, thoracic region
M54.2*	Cervicalgia
M54.6*	Pain in thoracic spine
M54.89*	Other dorsalgia
M54.9*	Dorsalgia, unspecified
M95.4	Acquired deformity of chest and rib
N64.4	Mastodynia
R20.2	Paresthesia of skin
R21*	Rash and other nonspecific skin eruption
Z85.3*	Personal history of malignant neoplasm of breast

Group 5 Medical Necessity ICD-10-CM Codes Asterisk Explanation

N/A

Group 6

(26 Codes)

Group 6 Paragraph

Rhinoplasty (CPT Codes 30400-30450)

Group 6 Codes

Code	Description
C30.0	Malignant neoplasm of nasal cavity
C41.0	Malignant neoplasm of bones of skull and face
C43.31	Malignant melanoma of nose
C43.39	Malignant melanoma of other parts of face
C44.311	Basal cell carcinoma of skin of nose
C44.319	Basal cell carcinoma of skin of other parts of face
C44.321	Squamous cell carcinoma of skin of nose
C44.329	Squamous cell carcinoma of skin of other parts of face
C44.391	Other specified malignant neoplasm of skin of nose
C44.399	Other specified malignant neoplasm of skin of other parts of face
C76.0	Malignant neoplasm of head, face and neck
D03.39	Melanoma in situ of other parts of face
D04.39	Carcinoma in situ of skin of other parts of face
D14.0	Benign neoplasm of middle ear, nasal cavity and accessory sinuses
D16.4	Benign neoplasm of bones of skull and face
D22.39	Melanocytic nevi of other parts of face
D23.39	Other benign neoplasm of skin of other parts of face
J34.0	Abscess, furuncle and carbuncle of nose
J34.1	Cyst and mucocele of nose and nasal sinus
J34.89	Other specified disorders of nose and nasal sinuses
S02.2XXA	Fracture of nasal bones, initial encounter for closed fracture
S02.2XXB	Fracture of nasal bones, initial encounter for open fracture
S02.2XXD	Fracture of nasal bones, subsequent encounter for fracture with routine healing
S02.2XXG	Fracture of nasal bones, subsequent encounter for fracture with delayed healing
S02.2XXK	Fracture of nasal bones, subsequent encounter for fracture with nonunion
S02.2XXS	Fracture of nasal bones, sequela

ICD-10-CM Codes that DO NOT Support Medical Necessity

Expand All | Collapse All

Group 1

Group 1 Paragraph

All ICD-10-CM codes not listed above under ICD-10-CM Codes That Support Medical Necessity above.

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
999x	Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
99999	Not Applicable

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
01/01/2021	R5	Updated Group 4: Medical Necessity ICD-10-CM Codes Asterisk Explanation to say: When billing for surgery on the unaffected breast to restore symmetry following breast cancer surgery on the contralateral breast, N65.1 must be used as the primary diagnosis with one of the C50.XXX ICD-10 codes as a secondary diagnosis.
01/01/2021	R4	Under CPT/HCPCS Codes Group 1: Descriptor Changes: 19318, 19325, 19328, 19330, 19340, 19342, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 01/01/2021.
01/01/2021	R3	Under CPT/HCPCS Codes Group 1: Deleted Codes:19324; 19366 Descriptor Changes: 15780; 15781; 15782; 15783; 19316 Under Group III Paragraph of ICD-10 codes that support Medical Necessity: Removed 19324 and 19366 This revision is due to the Q1 2021 CPT/HCPCS Code Update and is effective for dates of service on or after 01/01/2021.
10/01/2019	R2	Article converted to Billing and Coding. No change is coverage was made.
10/01/2019	R1	10/01/2019: Revised to add CPT codes 15838 and 15839 to Group 2 Paragraph.

Associated Documents

Related Local Coverage Documents
Articles
A55684 - Response to Comments: Plastic Surgery
LCDs
DL35163 - (MCD Archive Site)
L35163 - Plastic Surgery

Updated On	Effective Dates	Status
11/14/2023	10/01/2023 - N/A	Currently in Effect	View
08/23/2023	10/01/2023 - N/A	Superseded	View
10/25/2022	01/01/2021 - 09/30/2023	Superseded	You are here
02/11/2021	01/01/2021 - N/A	Superseded	View
02/04/2021	01/01/2021 - N/A	Superseded	View
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Billing and Coding: Plastic Surgery

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Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

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Response To Comments

Coding Information

Bill Type Codes

Revenue Codes

CPT/HCPCS Codes

Group 1

CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 2

Group 3

Group 4

Group 5

Group 6

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

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Group 1

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