Wiki Breast Reduction for symmetry - Medicare Part B Alabama

[acgibson@namccares.com]

CPT Code 19318
Medicare in Alabama's LCD only has one primary diagnosis (Macromastia) for breast reduction post mastectomy for symmetry. Not EVERY patient has that as a primary diagnosis. Other carriers have "Cancer" diagnoses as covered when listed as primary. I have contacted our Carrier and they "insinuate" that the 19318 code is incorrect, of course they will not tell me why. Anyone else with the same issue?

 

[nickelclaw]

how can you have a breast reduction after mastectomy? look into 19380

 

[vxhilaj]

how can you have a breast reduction after mastectomy? look into 19380

I think she means reduction on the opposite side.

 

[vxhilaj]

CPT Code 19318
Medicare in Alabama's LCD only has one primary diagnosis (Macromastia) for breast reduction post mastectomy for symmetry. Not EVERY patient has that as a primary diagnosis. Other carriers have "Cancer" diagnoses as covered when listed as primary. I have contacted our Carrier and they "insinuate" that the 19318 code is incorrect, of course they will not tell me why. Anyone else with the same issue?

We are having the same issue in Michigan. I tried billing 19316 just waiting on determination.