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LCD Reference Article Billing and Coding Article

Billing and Coding: Cosmetic and Reconstructive Surgery

A59299

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
CGS Administrators, LLC	MAC - Part A	15101 - MAC A	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part B	15102 - MAC B	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part A	15201 - MAC A	J - 15	Ohio
CGS Administrators, LLC	MAC - Part B	15202 - MAC B	J - 15	Ohio

Article Information

General Information

Article ID
A59299

Article Title
Billing and Coding: Cosmetic and Reconstructive Surgery

Article Type
Billing and Coding

Original Effective Date
05/28/2023

Revision Effective Date
11/16/2023

Revision Ending Date
N/A

Retirement Date
N/A

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 © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the 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

CMS PUB. 100-02 Medicare Benefit Policy Manual
Chapter 1 – Inpatient Hospital Services Covered under Part A
§120 - Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare
Chapter 16-General Exclusions from Coverage:
§120 Cosmetic Surgery
§180 - Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare.

CMS PUB. 100-3 Medicare National Coverage Determinations Manual
Chapter 1, Part 2
§140.2 - Breast Reconstruction Following Mastectomy
§140.4 - Plastic Surgery to Correct "Moon Face"
Chapter 1, Part 4
§250.4 – Treatment of Actinic Keratosis
§250.5 - Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome (LDS)

CMS PUB 100-04 Medicare Claims Processing Manual
Chapter 32 - Billing Requirements for Special Services
§260 - Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS)

National Coverage Determination 250.5 Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome

Title XVIII of the Social Security Act (SSA): 1862 (a)(1)(A) Medically Reasonable & Necessary tests used in the diagnosis and management of illness or injury or to improve the function of a malformed body part.
Title XVIII of the Social Security Act (SSA): 1862 (a)(1)(D) Investigational or Experimental.
Title XVIII of the Social Security Act, Section 1862 (a)(10). This section excludes Cosmetic Surgery.

Change Request 10901, Transmittal 829, Local Coverage Determinations (LCDs) October 3, 2018

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD DL39506 Cosmetic and Reconstructive Surgery.

This article will support reconstructive surgery performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease. It is generally performed to improve function but may also be done to approximate a normal appearance.

This article will not support cosmetic surgery performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem.

Coding Guidelines

Claims do not have to be submitted for cosmetic procedures. However, if a denial of Medicare coverage is necessary, a GY modifier (items or services statutorily excluded or does not meet the definition of any Medicare benefit) can be used on a cosmetic procedure to receive a non-covered denial. Use diagnosis code: Z41.1 Encounter for cosmetic surgery.
All submitted non-covered or no payment claims using condition code 21 will be processed to completion, and all services on those claims, since they are submitted as non-covered, will be denied. The default liability for payment of these claims is assigned to the beneficiary, who may then submit the denial from Medicare, as the primary payer, to subsequent payer(s) for consideration. Since a denial is a Medicare determination of payment, all services submitted on no payment claims may be appealed later if unusual circumstances so warrant. That is, all payment determinations are subject to appeal, even denials of services submitted as non-covered.

Documentation Requirements
For all procedures:

All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The medical record documentation must support the medical necessity of the services as stated in this policy.

Documentation Requirements for Specific Services

Reconstructive Surgery: Removal of Breast Implants

The medical record must describe the condition which supports the removal of a breast implant(s) as medically reasonable and necessary.

Breast Reduction

The beneficiary’s medical record must contain the following information:

Height and weight.
Body Surface Area (BSA)
Clinical evaluation of the signs and/or symptoms ascribed to the macromastia, therapies prior to breast reduction 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 with the weight of the tissue removed from each breast.
Documentation of back or neck or shoulder pain from macromastia that was unrelieved by 6 months of conservative analgesia, supportive measures (garment, etc.), and physical therapy.

Mastectomy for gynecomastia

Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography
Documentation that the gynecomastia persists, despite correction of any underlying causes
Documentation supporting that the gynecomastia is classified as Grade III or IV per the American Society of Plastic Surgeons classification
Documentation that hormonal causes, including hyperthyroidism, estrogen excess, hyperprolactinemia and hypogonadism have been excluded by appropriate laboratory testing (e.g. with levels of thyroid stimulating hormone [TSH], estradiol, prolactin, testosterone and or luteinizing hormone [LH])
Documentation supporting that gynecomastia persists after 6 months of unsuccessful medical treatment, the use of potential gynecomastia-inducing drugs and substances has been ruled out and gynecomastia persist for at least one year. (ASPS)

Tattooing or to correct color defects of the skin must indicate the prior condition i.e. post-mastectomy, trauma necessitating the reconstruction in the progress notes.

Punch graft hair transplants: pre-operative photographs must be made available upon Contractor request.

Rhinoplasty

The medical record must include a description of the condition requiring the rhinoplasty.
When performed for chronic obstruction the medical record must indicate what is causing the obstruction.
Documentation of anterior rhinoscopy, endoscopy, Cottle maneuver/modified Cottle maneuver and/or CT report is recommended to help support medical necessity if requested.
The medical record should include a description of any conservative treatment that has been utilized to treat obstruction and the length of time that the conservative treatment has been trialed.
Surgical/pathology report if post operative

Septoplasty

The medical record must contain the medical and antibiotic therapy that was utilized and the length of time treatment was trialed for recurrent sinusitis secondary to deviated septum.
When the procedure is being done for asymptomatic septal deformity to gain access to other transnasal areas during another medically necessary procedure the medical record must indicate what surgical procedure is being performed.
The medical record must contain the medical management utilized and the length of time that the treatment was trialed for obstructed nasal breathing due to septal deformity or deviation that is interfering with the effective use of Continuous Positive Airway Pressure (CPAP) for the treatment of an obstructive sleep disorder.

Abdominal Lipectomy/Panniculectomy

The beneficiary’s medical record must contain the following information:

the evaluation and management supporting the medical necessity and/or complications with decision to perform surgery,
surgical operative record,
description of the pannus and the underlying skin,
documentation that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing),
description of conservative treatment undertaken and its results,
evidence that the individual has maintained a stable weight for at least 6 months.

Rhytidectomy documentation should include the evaluation and management note in which the decision to perform surgery was made, surgical note and any notes documenting the functional impairment.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(108 Codes)

Group 1 Paragraph

The following ICD-10 codes support medical necessity and provider coverage for CPT Codes: 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380 and 19396 for Reconstructive Surgery: Removal of Breast Implants.
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 1 Codes

Code	Description
C44.501	Unspecified malignant neoplasm of skin of breast
C44.511	Basal cell carcinoma of skin of breast
C44.521	Squamous cell carcinoma of skin of breast
C44.591	Other specified malignant neoplasm of skin of breast
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
C50.511	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
C50.911	Malignant neoplasm of unspecified site of right female breast
C50.912	Malignant neoplasm of unspecified site of left female breast
C50.921	Malignant neoplasm of unspecified site of right male breast
C50.922	Malignant neoplasm of unspecified site 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
D05.91	Unspecified type of carcinoma in situ of right breast
D05.92	Unspecified 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
N60.01	Solitary cyst of right breast
N60.02	Solitary cyst of left breast
N60.11	Diffuse cystic mastopathy of right breast
N60.12	Diffuse cystic mastopathy of left breast
N60.21	Fibroadenosis of right breast
N60.22	Fibroadenosis of left breast
N60.31	Fibrosclerosis of right breast
N60.32	Fibrosclerosis of left breast
N60.41	Mammary duct ectasia of right breast
N60.42	Mammary duct ectasia of left breast
N60.81	Other benign mammary dysplasias of right breast
N60.82	Other benign mammary dysplasias of left breast
N60.91	Unspecified benign mammary dysplasia of right breast
N60.92	Unspecified benign mammary dysplasia of left breast
N65.0	Deformity of reconstructed breast
N65.1	Disproportion of reconstructed breast
T85.41XA - T85.41XS	Breakdown (mechanical) of breast prosthesis and implant, initial encounter - Breakdown (mechanical) of breast prosthesis and implant, sequela
T85.42XA - T85.42XS	Displacement of breast prosthesis and implant, initial encounter - Displacement of breast prosthesis and implant, sequela
T85.43XA - T85.43XS	Leakage of breast prosthesis and implant, initial encounter - Leakage of breast prosthesis and implant, sequela
T85.44XA - T85.44XS	Capsular contracture of breast implant, initial encounter - Capsular contracture of breast implant, sequela
T85.49XA - T85.49XS	Other mechanical complication of breast prosthesis and implant, initial encounter - Other mechanical complication of breast prosthesis and implant, sequela
T85.79XA - T85.79XS	Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter - Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, sequela
T85.818A	Embolism due to other internal prosthetic devices, implants and grafts, initial encounter
T85.828A	Fibrosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.838A	Hemorrhage due to other internal prosthetic devices, implants and grafts, initial encounter
T85.848A	Pain due to other internal prosthetic devices, implants and grafts, initial encounter
T85.858A	Stenosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.868A	Thrombosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.898A	Other specified complication of other internal prosthetic devices, implants and grafts, initial encounter
Z15.01	Genetic susceptibility to malignant neoplasm of breast
Z42.1	Encounter for breast reconstruction following mastectomy
Z44.31	Encounter for fitting and adjustment of external right breast prosthesis
Z44.32	Encounter for fitting and adjustment of external left breast prosthesis
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
Z80.3	Family history of malignant neoplasm of breast
Z85.3	Personal history of malignant neoplasm of breast
Z90.11	Acquired absence of right breast and nipple
Z90.12	Acquired absence of left breast and nipple
Z90.13	Acquired absence of bilateral breasts and nipples
Z98.82	Breast implant status

Group 2

(1 Code)

Group 2 Paragraph

Breast Reduction (CPT 19318) and Mastectomy for Gynecomastia (CPT 19300)
Primary Diagnosis:

Group 2 Codes

Code	Description
N62*	Hypertrophy of breast

Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: When billing CPT 19318 a secondary diagnosis is needed from Group 3.

Group 3

(19 Codes)

Group 3 Paragraph

Breast Reduction (CPT 19318)
The primary diagnosis must be billed with one of the following secondary diagnoses:
Secondary Diagnoses

Group 3 Codes

Code	Description
L26	Exfoliative dermatitis
L30.4	Erythema intertrigo
L53.8	Other specified erythematous conditions
L54	Erythema in diseases classified elsewhere
L95.1	Erythema elevatum diutinum
L98.9	Disorder of the skin and subcutaneous tissue, unspecified
M25.511	Pain in right shoulder
M25.512	Pain in left shoulder
M54.2	Cervicalgia
M54.6	Pain in thoracic spine
M54.89	Other dorsalgia
N64.1	Fat necrosis of breast
N64.81	Ptosis of breast
N65.1	Disproportion of reconstructed breast
O91.211	Nonpurulent mastitis associated with pregnancy, first trimester
O91.212	Nonpurulent mastitis associated with pregnancy, second trimester
O91.213	Nonpurulent mastitis associated with pregnancy, third trimester
R21	Rash and other nonspecific skin eruption
Z48.3*	Aftercare following surgery for neoplasm

Group 3 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use Z48.3 to indicate a mammoplasty to reduce the size of a normal breast to bring it into symmetry with a breast reconstructed after cancer surgery. When reporting Z48.3 it is not necessary to report N62.

Group 4

(3 Codes)

Group 4 Paragraph

Tattooing (CPT 11920, 11921, 11922)

Group 4 Codes

Code	Description
L81.8	Other specified disorders of pigmentation
L81.9	Disorder of pigmentation, unspecified
Z42.8	Encounter for other plastic and reconstructive surgery following medical procedure or healed injury

Group 5

(31 Codes)

Group 5 Paragraph

Punch graft hair transplant (CPT 15775-15776)
For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 5 Codes

Code	Description
C44.300	Unspecified malignant neoplasm of skin of unspecified part of face
C44.309	Unspecified malignant neoplasm of skin of other parts of face
C44.310	Basal cell carcinoma of skin of unspecified parts of face
C44.319	Basal cell carcinoma of skin of other parts of face
C44.320	Squamous cell carcinoma of skin of unspecified parts of face
C44.329	Squamous cell carcinoma of skin of other parts of face
C44.390	Other specified malignant neoplasm of skin of unspecified parts of face
C44.399	Other specified malignant neoplasm of skin of other parts of face
D04.30	Carcinoma in situ of skin of unspecified part of face
D04.39	Carcinoma in situ of skin of other parts of face
D04.8	Carcinoma in situ of skin of other sites
D22.30	Melanocytic nevi of unspecified part of face
D22.39	Melanocytic nevi of other parts of face
D23.30	Other benign neoplasm of skin of unspecified part of face
D23.39	Other benign neoplasm of skin of other parts of face
D48.5	Neoplasm of uncertain behavior of skin
S09.10XA	Unspecified injury of muscle and tendon of head, initial encounter
S09.11XA	Strain of muscle and tendon of head, initial encounter
S09.19XA	Other specified injury of muscle and tendon of head, initial encounter
S09.8XXA	Other specified injuries of head, initial encounter
T20.06XA - T20.06XS	Burn of unspecified degree of forehead and cheek, initial encounter - Burn of unspecified degree of forehead and cheek, sequela
T20.16XA - T20.16XS	Burn of first degree of forehead and cheek, initial encounter - Burn of first degree of forehead and cheek, sequela
T20.26XA	Burn of second degree of forehead and cheek, initial encounter
T20.36XA	Burn of third degree of forehead and cheek, initial encounter
T20.66XA	Corrosion of second degree of forehead and cheek, initial encounter
T20.76XA	Corrosion of third degree of forehead and cheek, initial encounter
Z48.89*	Encounter for other specified surgical aftercare

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

*Note: Use Z48.89 to report punch graft procedures performed for eyebrow replacement due to removal of tumor.

Group 6

(54 Codes)

Group 6 Paragraph

Rhinoplasty/Nasal Reconstruction (CPT codes 30400-30450, 30460, 30462, 30520)
For codes that require a 7th character, letters A,B,D,G,K, or S may be used. Use J34.89 to indicate nasal obstruction.

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
C44.301	Unspecified malignant neoplasm of skin of nose
C44.309	Unspecified malignant neoplasm of skin 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
J32.0	Chronic maxillary sinusitis
J32.1	Chronic frontal sinusitis
J32.2	Chronic ethmoidal sinusitis
J32.3	Chronic sphenoidal sinusitis
J32.4	Chronic pansinusitis
J34.0	Abscess, furuncle and carbuncle of nose
J34.1	Cyst and mucocele of nose and nasal sinus
J34.2	Deviated nasal septum
J34.89	Other specified disorders of nose and nasal sinuses
Q30.0	Choanal atresia
Q30.8	Other congenital malformations of nose
Q35.1	Cleft hard palate
Q35.3	Cleft soft palate
Q35.5	Cleft hard palate with cleft soft palate
Q35.7	Cleft uvula
Q36.0	Cleft lip, bilateral
Q36.1	Cleft lip, median
Q36.9	Cleft lip, unilateral
Q37.0	Cleft hard palate with bilateral cleft lip
Q37.1	Cleft hard palate with unilateral cleft lip
Q37.2	Cleft soft palate with bilateral cleft lip
Q37.3	Cleft soft palate with unilateral cleft lip
Q37.4	Cleft hard and soft palate with bilateral cleft lip
Q37.5	Cleft hard and soft palate with unilateral cleft lip
Q67.0	Congenital facial asymmetry
Q67.1	Congenital compression facies
Q67.4	Other congenital deformities of skull, face and jaw
R04.0	Epistaxis
R09.81	Nasal congestion
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

Group 7

(1 Code)

Group 7 Paragraph

Chemical Peel (CPT 15788-15793)

Group 7 Codes

Code	Description
L57.0	Actinic keratosis

Group 8

(6 Codes)

Group 8 Paragraph

Abdominal lipectomy/panniculectomy (CPT 15830, 15847, 15877)

Group 8 Codes

Code	Description
E65*	Localized adiposity
L30.4*	Erythema intertrigo
L98.7	Excessive and redundant skin and subcutaneous tissue
M79.3	Panniculitis, unspecified
R26.2*	Difficulty in walking, not elsewhere classified
Z74.09*	Other reduced mobility

Group 8 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: dual diagnosis reporting is required to support the service as medically reasonable and necessary. ICD-10 diagnosis codes L98.7 or M79.3 should be reported as the primary diagnosis with ICD-10 codes E65, L30.4, R26.2, or Z74.09 reported as the secondary diagnosis.

Group 9

(2 Codes)

Group 9 Paragraph

Dermal Filler injection(s) (G0429), Injection, Radiesse, 0.1ml (Q2026), Injection, Sculptra, 0.1ml (Q2028).
Both diagnoses are required on the claim. Q2026 and Q2028 must be billed with G0429

Group 9 Codes

Code	Description
B20	Human immunodeficiency virus [HIV] disease
E88.1	Lipodystrophy, not elsewhere classified

Group 10

Group 10 Paragraph

Rhytidectomy (CPT 15828, 15829)

Group 10 Codes

N/A

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

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Group 1

(1 Code)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
Z41.1	Encounter for cosmetic surgery

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
Please accept the License to see the codes.

N/A

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
Please accept the License to see the codes.

N/A

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
11/16/2023	R2	Revision Effective: 11/16/2023 Revision Explanation: Updated LCD Reference Article section.
05/28/2023	R1	R1 Revision Effective: 05/28/2023 Revision Explanation: Removed N62 from ICD-10 group 3 as it was added in error.

Associated Documents

Related Local Coverage Documents
LCDs
L39506 - Cosmetic and Reconstructive Surgery

Updated On	Effective Dates	Status
11/08/2023	11/16/2023 - N/A	Currently in Effect	You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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Billing and Coding: Cosmetic and Reconstructive Surgery

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ICD-10-CM Codes that Support Medical Necessity

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