Reimbursement Policy Cosmetic and … and Reconstructive Services and ... • Cosmetic surgery to...

Reimbursement Policy

Cosmetic and Reconstructive Services and Procedures

Proprietary information of UnitedHealthcare. Copyright 2014 United HealthCare Services, Inc.

Policy Number

COS04232014RP Approved By

UnitedHealthcare Medicare Reimbursement Policy Committee

Current Approval Date

04/23/2014

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates. You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS), or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms (CMS 1450). Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general resource regarding UnitedHealthcare’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare enrollees. Other factors affecting reimbursement may supplement, modify or, in some cases, supersede this policy. These factors may include, but are not limited to: legislative mandates, the physician or other provider contracts, and/or the enrollee’s benefit coverage documents. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare due to programming or other constraints; however, UnitedHealthcare strives to minimize these variations. UnitedHealthcare may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT copyright 2010 (or such other date of publication of CPT) American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


Table of Contents Application ......................................................................................................................................2 Summary .........................................................................................................................................2

Overview........................................................................................................................................2 Reimbursement Guidelines ...............................................................................................................2 Cosmetic Clinical Indications .............................................................................................................2 Reconstructive Clinical Indications .....................................................................................................3 Documentation Requirements ...........................................................................................................5

Coding Criteria: Reconstructive Breast Surgery...............................................................................7 Coding Criteria: Reduction Mammoplasty ........................................................................................7 Coding Criteria: Breast Implants .....................................................................................................8 Coding Criteria: Tattooing ...............................................................................................................10 Coding Criteria: Hair Transplant ......................................................................................................10 Coding Criteria: Rhinoplasty ............................................................................................................10 Coding Criteria: Chemical Peel ........................................................................................................12 Coding Criteria: Dermabrasion ........................................................................................................14 Coding Criteria: Dermal Injections ..................................................................................................15 Coding Criteria: Abdominal Lipectomy/Panniculectomy ..................................................................15 Coding Criteria: Myocutaneous Flaps ...............................................................................................15 Coding Criteria: Cosmetic ................................................................................................................16 Questions and Answers ...................................................................................................................17




References Included (but not limited to): .......................................................................................17 CMS NCD(s) ...................................................................................................................................17 CMS LCD(s) ....................................................................................................................................17 CMS Benefit Policy Manual ................................................................................................................17 CMS Claims Processing Manual .........................................................................................................17 UnitedHealthcare Medicare Advantage Coverage Summaries ................................................................17 UnitedHealthcare Coverage Determination Guidelines (CDGs) ...............................................................17 Others ...........................................................................................................................................18

History ............................................................................................................................................18 Application This reimbursement policy applies to services reported using the Health Insurance Claim Form CMS-1500 or its electronic equivalent or its successor form, and services reported using facility claim form CMS-1450 or its electronic equivalent or its successor form. This policy applies to all products, all network and non-network physicians, and other health care professionals. 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 UnitedHealthcare. It is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis must be present for the procedure to be paid. Compliance with the provisions in this policy is subject to monitoring by pre-payment review and/or post-payment data analysis and subsequent medical review. The effective date of changes/additions/deletions to this policy is the committee meeting date unless otherwise indicated. CPT codes and descriptions are copyright 2010 American Medical Association (or such other date of publication of CPT). All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS restrictions apply to Government use. 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. Current Dental Terminology (CDT), including procedure codes, nomenclature, descriptors, and other data contained therein, is copyright by the American Dental Association, 2002, 2004. All rights reserved. CDT is a registered trademark of the American Dental Association. Applicable FARS/DFARS apply. Summary Overview The purpose of this policy is to clarify the Medicare coverage of cosmetic vs. reconstructive surgical procedures. Section 1862(a) (1) (A) of Title XVIII of the Social Security Act provides in part that "...no payment may be made under Part A or B (of Medicare) for any expenses incurred for items or services which...are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Reimbursement Guidelines According to the American Society of Plastic and Reconstructive Surgeons, the specialty of plastic surgery includes cosmetic and reconstructive procedures: A. Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's

appearance and self-esteem. B. Reconstructive surgery is 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.

Cosmetic Clinical Indications • Corrective facial surgery is usually not covered when there is no functional impairment present; • A mastopexy performed primarily to lift or reshape the breast and unrelated to breast reconstruction

following surgery for breast cancer; • Cosmetic surgery to reshape the breasts to improve appearance is not a Medicare benefit. A reduction

mammoplasty is the surgical reshaping of the breasts to reduce or lift enlarged or sagging breasts to




improve the appearance of the breast. Cosmetic signs and/or symptoms would include ptosis, poorly fitting clothing and beneficiary perception of unacceptable appearance.

• Suction assisted lipectomy to remove localized collections of unwanted fat in order to improve appearance; • Eye surgery that does not correct a functional impairment; • Reimbursement for a non-covered procedure performed at the same operative session as a covered

surgical procedure will not be allowed; • Mastectomy for gynecomastia when the tissue removed is primarily fatty tissue; • Nasal surgery performed solely to improve the patient's appearance in the absence of any signs and/or

symptoms of functional abnormalities; • Rhinoplasty is not covered when performed for either of the following indications:

o Solely for the purpose of changing appearance. o As a primary treatment for an obstructive sleep disorder.

• Excision, excessive skin and subcutaneous tissue (including lipectomy); abdomen (abdominoplasty) when performed to improve the patient's appearance;

• Chemical Peel when done for a cosmetic reason; • Dermabrasion, segmental, face when performed for a cosmetic reason (i.e., post-acne scarring); and • Rhytidectomy when performed for a cosmetic reason • Abdominoplasty or panniculectomy are not covered when performed primarily for any of the following

indications because it is considered not medically necessary (this list may not be all-inclusive): o Treatment of neck or back pain o Improving appearance (i.e., cosmesis) o Repairing abdominal wall laxity or diastasis recti o Treating psychological symptomatology or psychosocial complaints o When performed in conjunction with abdominal or gynecological. procedures (e.g., abdominal hernia

repair, hysterectomy, obesity surgery) unless criteria for panniculectomy and abdominoplasty are met separately.

Reconstructive Clinical Indications • Surgical procedures to replace absent breast tissue secondary to prior tumor removal, trauma, infection or

to correct a gross variation in breast size, that is developmental or post-mastectomy; • Breast reconstruction of the affected and the contralateral unaffected breast following a medically

necessary mastectomy; • Breast augmentation or reduction mammoplasty is covered in the presence of an acquired deformity of the

breast and breast carcinoma; • Reduction mammoplasty is limited to circumstances in which there are signs and/or symptoms resulting

from the enlarged breasts (macromastia) that have not responded adequately to Non-surgical Interventions and/or to reduce the size of a normal breast to bring it in symmetry with a breast reconstructed after cancer surgery;

• A medically reasonable and necessary reduction mammoplasty could be indicated in the presence of significantly enlarged breasts and the presence of at least one of the following signs and/or symptoms: o Back and neck or shoulder pain from macromastia and unrelieved by 6 months of:

Conservative analgesia, Supportive measures (garment, etc.), Physical Therapy, or

o Significant arthritic changes in the cervical or upper thoracic spine, optimally managed with persistent symptoms and/or significant restriction of activity

o Intertriginous maceration or infection of the inflammatory skin refractory to dermatologic measures o Permanent shoulder grooving with skin irritation by supporting garment (bra strap)




• Removal or revision of breast implant is considered medically necessary when it is removed for one of the following reasons: o Mechanical complication of breast prosthesis; including rupture or failed implant; o Infection or inflammatory reaction due to breast prosthesis; including infected breast implant, or

rejection of breast implants; o Implant extrusion; o Siliconoma or granuloma; o Interference with diagnosis of breast cancer; o Breast pain; and o Painful capsular contracture with disfigurement.

• Mastectomy for gynecomastia if it is documented that the tissue is primarily breast tissue and not just adipose (fatty tissue)

• Tattooing to correct color defects of the skin may be considered reconstructive when performed in connection with a payable post-mastectomy reconstruction, or for reconstruction following trauma or removal of cancer from an eyelid, eyebrow or lip(s)

• Punch graft hair transplant may be considered reconstructive when it is performed for eyebrow(s) replacement following a burn injury or tumor removal

• Chemical Peel is covered for the treatment of actinic keratosis • Segmental dermabrasion of the face is covered for the treatment of rhinophyma • Dermal injections for facial LDS using dermal fillers approved by the FDA for this purpose, and then only in

HIV-infected Medicare beneficiaries who manifest depression secondary to the physical stigma of HIV treatment will be covered (See Pub. 100-03, NCD, chapter 1, section 250.5, for specific coverage criteria. See Pub. 100-04, Claims Processing Manual, chapter 32, section 260, for specific claims payment/coding instructions)

• Surgical removal of excessive fat and skin from the abdomen when the surgery is to alleviate complicating factors such as: o Inability to walk normally; o Chronic pain; and o Ulceration or infection created by the abdominal skin fold or dermatitis.

• Excision, excessive skin and subcutaneous tissue (including lipectomy); abdomen (abdominoplasty) will only be considered reasonable and medically necessary when these procedures are performed due to another surgery being done at the same time and would affect the healing of the surgical incision

• Excision, excessive skin and subcutaneous tissue (including lipectomy); abdomen (abdominoplasty) will be covered for the patient that has had a significant weight-loss following the treatment of morbid obesity and there are medical complications such as candidiasis, intertrigo, or tissue necrosis that is unresponsive to oral or topical medication

• Suction assisted lipectomy to remove a lipoma, unless lipoma is the etiology of critical symptoms or other disease such as erosion, obstruction of contiguous structure;

• Repair of the upper eyelid when skin is sufficiently low to produce functional complaints, causing visual field impairment; and

• Nasal surgery generally performed to improve the following: o Respiratory function due to airway obstruction or stricture; o Correct anatomic abnormalities caused by birth defects or disease, or revise structural deformities

produced by trauma; o Revise structural deformities due to nasal cutaneous disease; o Treat congenital anatomic anomalies; such as cleft lip nasal deformities, choanal atresia, and oronasal

or oromaxillary fistula; and o Replace nasal tissue lost after tumor ablation.

• Rhinoplasty when there is photographic documentation (all of the following: frontal, lateral and worm’s eye view) of the individual’s condition, and the procedure is performed for correction or repair of any of the following:




o Nasal deformity secondary to a cleft lip/palate or other congenital craniofacial deformity causing a functional impairment.

o Chronic, nonseptal, nasal obstruction due to vestibular stenosis (i.e., collapsed internal valves). o Secondary to trauma, disease, congenital defect with nasal airway obstruction unresponsive to a recent

trial of conservative medical management lasting at least six weeks that has either not resolved after previous septoplasty/turbinectomy or would not be expected to resolve with septoplasty/turbinectomy alone.

• Septoplasty is considered medically necessary when performed for any of the following indications: o Septal deviation causing nasal airway obstruction that has proved unresponsive to a recent trial of

conservative medical management lasting at least six weeks. o Recurrent sinusitis secondary to a deviated septum that does not resolve after appropriate medical and

antibiotic therapy. o Recurrent epistaxis related to a septal deformity. o Asymptomatic septal deformity that prevents access to other transnasal areas when such access is

required to perform medically necessary procedures (e.g., ethmoidectomy). o Performed in association with cleft lip or cleft palate repair. o Obstructed nasal breathing due to septal deformity or deviation that has proved unresponsive to

medical management and is interfering with the effective use of medically necessary Continuous Positive Airway Pressure (CPAP) for the treatment of an obstructive sleep disorder.

Documentation Requirements Reduction Mammoplasty documentation should include the evaluation and management note for the date of service and the note for the day the decision to perform surgery was made. The beneficiary's medical record must contain, and be available for review on request, the following information: 1. Height and weight 2. Body Surface Area (BSA) 3. Clinical evaluation of the signs and/or symptoms ascribed to the macromastia, therapies prior to reduction

mammoplasty and the responses to these therapies. 4. The operative report with documentation of the weight of tissue removed from each breast, obtained in the

operating room. 5. The pathology report with the weight of the tissue removed from each breast. 6. 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. Abdominoplasty documentation must contain a description of the pannus and the underlying skin and a description of conservative treatment undertaken and the results of that treatment. The medical record should also include the evaluation and management note in which the decision to perform surgery was made, surgical note and any notes indicating medical complications necessitating the surgery. 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. Pre-operative photographs must be made available upon UnitedHealthcare request for punch graft hair transplants. Documentation in the progress notes for tattooing, to correct color defects of the skin must indicate the prior condition i.e. post-mastectomy, trauma necessitating the reconstruction. For dermal injections, the medical record must contain conclusive evidence of the diagnosis of HIV and treatment with Highly Active Antiretroviral Therapy (HAART). In addition, description of facial abnormalities consistent with FLS must be present as well as description of depressive symptoms and any treatments undertaken. Claims do not have to be submitted for cosmetic procedures. However, if a denial of UnitedHealthcare Medicare and Retirement coverage is necessary, a GY modifier (items or services statutorily excluded or does not meet the definition of any UnitedHealthcare Medicare and Retirement benefit) can be used on a cosmetic procedure to receive a non-covered denial.




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 UnitedHealthcare, as the primary payer, to subsequent payer(s) for consideration. Flaps (Skin and/or Deep Tissues) Procedures: 15570 - 15738 • The regions listed in 15570 – 15738 refer to a donor site when a tube is formed for later transfer or when

a “delay” of flap occurs prior to the transfer • Codes 15732 – 15738 are described by donor site of the muscle, myocutaneous or fasciocutaneous flap • A repair of a donor site requiring a skin graft or local flaps is considered an additional separate procedure • CPT codes 15756 – 15758 represent microvascular flaps • CPT codes 15570 – 15576 represent flaps without inclusion of a vascular pedicle • CPT codes 14000 – 14302 represent flaps for adjacent tissue transfer • Regions listed in adjacent tissue transfer codes refer to recipient area (not the donor site) when a flap is

being attached in a transfer or to a final site • Codes 15570 – 15738 do not include extensive immobilization (e.g., large plaster casts and other

immobilizing devices are considered additional separate procedures) Other Flaps and Grafts Procedures: 15740 - 15777 • 15740 - The physician forms an island pedicle flap. A defect is covered by elevation of a flap of skin and

subcutaneous tissue from a nearby but not immediately adjacent donor site. The flap involves an anatomically named blood vessel in its creation. Often this tissue will be transferred through a tunnel underneath the skin and sutured into its new position. The donor site is closed directly.

• Neurovascular pedicle procedures are reported with 15750. Report 15750 if the pedicle is neurovascular, containing functional motor or sensory nerve(s) and blood vessel elements. A neurovascular pedicle flap (15750) is a type of graft where the pedicle consists of the artery and vein that provide the blood supply and includes the nerve as well. In both cases, repair of the donor site that requires a skin graft or local flaps is considered an additional, separate procedure and should be coded separately. Extensive immobilization and/or repair of the donor site is reported separately.

• This flap serves to re-innervate a damaged portion of the body dependent on touch or movement (e.g., thumb).

• The flap is typically transferred through a tunnel underneath the skin and sutured into its new position. • For random island flaps, V-Y subcutaneous flaps, advancement flaps and other flaps from adjacent areas

without clearly defined anatomically named axial vessels; see 14000 – 14302. Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare Services "related to" cosmetic surgery including services related to follow-up care and complications of non-covered services which require treatment during a hospital stay in which the non-covered service was performed, are not covered services under Medicare. After a beneficiary has been discharged from the hospital stay in which the beneficiary received non-covered services, medical and hospital services required to treat a condition or complication that arises as a result of the prior non-covered services may be covered when they are reasonable and necessary in all other respects. Thus, coverage could be provided for subsequent inpatient stays or outpatient treatment ordinarily covered by Medicare, even if the need for treatment arose because of a previous non-covered procedure. Some examples of services that may be found to be covered under this policy are the reversal of intestinal bypass surgery for obesity, repair of complications from breast augmentation surgery, removal of a non-covered breast prosthesis, or treatment of any infection at the surgical site of a cosmetic procedure that occurred following discharge from the hospital. However, any subsequent services that could be expected to have been incorporated into a global fee are not covered. Thus, where a patient undergoes cosmetic surgery and the treatment regimen calls for a series of postoperative visits to the surgeon for evaluating the patient's progress, these visits are not covered.




Coding Criteria: Reconstructive Breast Surgery CPT/HCPCS Codes Code Description 19316 Mastopexy 19324 Mammaplasty, augmentation; without prosthetic implant 19325 Mammaplasty, augmentation; with prosthetic implant 19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 19342 Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 19350 Nipple/areola reconstruction 19355 Correction of inverted nipples 19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent

expansion 19361 Breast reconstruction with latissimus dorsi flap, without prosthetic implant 19364 Breast reconstruction with free flap 19366 Breast reconstruction with other technique 19367 Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single

pedicle, including closure of donor site; 19368 Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single

pedicle, including closure of donor site; with microvascular anastomosis (supercharging) 19369 Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double

pedicle, including closure of donor site 19370 Open periprosthetic capsulotomy, breast (see Coding Criteria for Breast Implants also) 19371 Periprosthetic capsulectomy, breast (see Coding Criteria for Breast Implants also) 19380 Revision of reconstructed breast (see Coding Criteria for Breast Implants also) 19396 Preparation of moulage for custom breast implant Anesthesia Codes Code Description 00402 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and

perineum; reconstructive procedures on breast (e.g., reduction or augmentation mammoplasty, muscle flaps)

ICP/PCS Codes

Recon Breast Surgery ICP-PCS Cod

Coding Criteria: Reduction Mammoplasty CPT/HCPCS Codes Code Description 19318 Reduction mammoplasty ICP/PCS Codes ICP Code Description PCS Code Description 85.31 Unilateral reduction mammoplasty 0H0T0ZZ Alteration of right breast, open

approach 0H0U0ZZ Alteration of left breast, open

approach




0H0V0ZZ Alteration of bilateral breast, open approach

0HBT0ZZ Excision of right breast, open approach

0HBU0ZZ Excision of left breast, open approach 0HBV0ZZ Excision of bilateral breast, open

approach 85.32 Bilateral reduction mammoplasty 0H0T0ZZ Alteration of right breast, open

approach 0H0U0ZZ Alteration of left breast, open

approach 0H0V0ZZ Alteration of bilateral breast, open

approach 0HBT0ZZ Excision of right breast, open

approach 0HBU0ZZ Excision of left breast, open approach 0HBV0ZZ Excision of bilateral breast, open

approach Coding Criteria: Breast Implants CPT/HCPCS Codes Code Description 19328 Removal of intact mammary implant 19330 Removal of mammary implant material 19370 Open periprosthetic capsulotomy, breast (See Coding Criteria for Reconstructive Breast

Surgery also) 19371 Periprosthetic capsulectomy, breast (See Coding Criteria for Reconstructive Breast Surgery

also) 19380 Revision of reconstructed breast (See Coding Criteria for Reconstructive Breast Surgery also) ICP/PCS Codes ICP Code Description PCS Code Description 85.0 Mastotomy 0HNT0ZZ Release right breast, open approach

0HNU0ZZ Release left breast, open approach 0HNV0ZZ Release bilateral breast, open

approach 0HNW0ZZ Release right nipple, open approach 0HNX0ZZ Release left nipple, open approach 0HPT0JZ Removal of synthetic substitute from

right breast, open approach 0HPU0JZ Removal of synthetic substitute from

left breast, open approach 85.21 Local excision of lesion of breast 0HNT0ZZ Release right breast, open approach

0HNU0ZZ Release left breast, open approach 0HNV0ZZ Release bilateral breast, open

approach 0HNW0ZZ Release right nipple, open approach




0HNX0ZZ Release left nipple, open approach 0HPT0JZ Removal of synthetic substitute from


left breast, open approach 85.93 Revision of implant of breast 0HBT0ZZ Excision of right breast, open

approach 0HBU0ZZ Excision of left breast, open approach 0HQT0ZZ Repair right breast, open approach 0HQU0ZZ Repair left breast, open approach 0HQW0ZZ Repair right nipple, open approach 0HQX0ZZ Repair left nipple, open approach 0HWT0JZ Revision of synthetic substitute in

right breast, open approach 0HWU0JZ Revision of synthetic substitute in left

breast, open approach 85.94 Removal of implant of breast 0HPT0JZ Removal of synthetic substitute from


left breast, open approach Coding Criteria: Mastectomy for Gynecomastia CPT/HCPCS Codes Code Description 19300 Mastectomy for gynecomastia ICP/PCS Codes ICP Code Description PCS Code Description 85.31 Unilateral reduction mammoplasty 0HBT0ZZ Excision of right breast, open


approach 85.32 Bilateral reduction mammoplasty 0HBT0ZZ Excision of right breast, open


approach 85.34 Other unilateral subcutaneous

mammectomy 0HBT0ZZ Excision of right breast, open


approach 85.36 Other bilateral subcutaneous

mammectomy 0HBT0ZZ Excision of right breast, open

approach 0HBU0ZZ Excision of left breast, open approach




0HBV0ZZ Excision of bilateral breast, open approach

Coding Criteria: Tattooing CPT/HCPCS Codes Code Description 11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of

skin, including micropigmentation; 6.0 sq cm or less 11921 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of

skin, including micropigmentation; 6.1 to 20.0 sq cm 11922 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of

skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (list separately in addition to code for primary procedure)

ICP/PCS Codes ICP Code Description PCS Code Description 86.02 Injection or tattooing of skin lesion or

defect 3E00XMZ Introduction of pigment into skin and

mucous membranes, external approach

Coding Criteria: Hair Transplant CPT/HCPCS Codes Code Description 15775 Punch graft for hair transplant; 1 to 15 punch grafts 15776 Punch graft for hair transplant; more than 15 punch grafts ICP/PCS Codes ICP Code Description PCS Code Description 86.64 Hair transplant 0HRSX7Z Replacement of hair with autologous

tissue substitute, external approach 0HRSXJZ Replacement of hair with synthetic

substitute, external approach 0HRSXKZ Replacement of hair with

nonautologous tissue substitute, external approach

Coding Criteria: Rhinoplasty CPT/HCPCS Codes Code Description 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) 30460 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including

columellar lengthening; tip only 30462 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including

columellar lengthening; tip, septum, osteotomies




ICP/PCS Codes ICP Code Description PCS Code Description 21.5 Submucous resection of nasal septum 090K0ZZ Alteration of nose, open approach

09RM07Z Replacement of nasal septum with autologous tissue substitute, open approach

09TM0ZZ Resection of nasal septum, open approach

09UM07Z Supplement nasal septum with autologous tissue substitute, open approach

21.83 Total nasal reconstruction 090K0ZZ Alteration of nose, open approach 09RK07Z Replacement of nose with autologous

tissue substitute, open approach 09UK07Z Supplement nose with autologous

tissue substitute, open approach 0NRB07Z Replacement of nasal bone with

autologous tissue substitute, open approach

0NUB07Z Supplement nasal bone with autologous tissue substitute, open approach

21.84 Revision rhinoplasty 090K0ZZ Alteration of nose, open approach 09QK0ZZ Repair nose, open approach 09RK0KZ Replacement of nose with

nonautologous tissue substitute, open approach

09UK0KZ Supplement nose with nonautologous tissue substitute, open approach

0NQB0ZZ Repair nasal bone, open approach 21.86 Limited rhinoplasty 090K0ZZ Alteration of nose, open approach

09RK07Z Replacement of nose with autologous tissue substitute, open approach

09UK07Z Supplement nose with autologous tissue substitute, open approach

0NRB07Z Replacement of nasal bone with autologous tissue substitute, open approach


21.87 Other rhinoplasty 090K0ZZ Alteration of nose, open approach 09RK07Z Replacement of nose with autologous

tissue substitute, open approach 09UK07Z Supplement nose with autologous

tissue substitute, open approach




0NRB07Z Replacement of nasal bone with autologous tissue substitute, open approach


09RM07Z Replacement of nasal septum with autologous tissue substitute, open approach



21.88 Other septoplasty 090K0ZZ Alteration of nose, open approach 09RM07Z Replacement of nasal septum with

autologous tissue substitute, open approach



21.89 Other repair and plastic operations on nose

09QK0ZZ Repair nose, open approach 09RK0KZ Replacement of nose with

nonautologous tissue substitute, open approach

09UK0KZ Supplement nose with nonautologous tissue substitute, open approach

0NQB0ZZ Repair nasal bone, open approach 090K0ZZ Alteration of nose, open approach

Coding Criteria: Chemical Peel CPT/HCPCS Codes Code Description 15788 Chemical peel, facial; epidermal 15789 Chemical peel, facial; dermal 15792 Chemical peel, nonfacial; epidermal 15793 Chemical peel, nonfacial; dermal ICP/PCS Codes ICP Code Description PCS Code Description 86.24 Chemosurgery of skin 0H50XZD Destruction of scalp skin, multiple,

external approach 0H50XZZ Destruction of scalp skin, external

approach 0H51XZD Destruction of face skin, multiple,

external approach




0H51XZZ Destruction of face skin, external approach

0H52XZD Destruction of right ear skin, multiple, external approach

0H52XZZ Destruction of right ear skin, external approach

0H53XZD Destruction of left ear skin, multiple, external approach

0H53XZZ Destruction of left ear skin, external approach

0H54XZD Destruction of neck skin, multiple, external approach

0H54XZZ Destruction of neck skin, external approach

0H55XZD Destruction of chest skin, multiple, external approach

0H55XZZ Destruction of chest skin, external approach

0H56XZD Destruction of back skin, multiple, external approach

0H56XZZ Destruction of back skin, external approach

0H57XZD Destruction of abdomen skin, multiple, external approach

0H57XZZ Destruction of abdomen skin, external approach

0H58XZD Destruction of buttock skin, multiple, external approach

0H58XZZ Destruction of buttock skin, external approach

0H59XZD Destruction of perineum skin, multiple, external approach

0H59XZZ Destruction of perineum skin, external approach

0H5AXZD Destruction of genitalia skin, multiple, external approach

0H5AXZZ Destruction of genitalia skin, external approach

0H5BXZD Destruction of right upper arm skin, multiple, external approach

0H5BXZZ Destruction of right upper arm skin, external approach

0H5CXZD Destruction of left upper arm skin, multiple, external approach

0H5CXZZ Destruction of left upper arm skin, external approach




0H5DXZD Destruction of right lower arm skin, multiple, external approach

0H5DXZZ Destruction of right lower arm skin, external approach

0H5EXZD Destruction of left lower arm skin, multiple, external approach

0H5EXZZ Destruction of left lower arm skin, external approach

0H5FXZD Destruction of right hand skin, multiple, external approach

0H5FXZZ Destruction of right hand skin, external approach

0H5GXZD Destruction of left hand skin, multiple, external approach

0H5GXZZ Destruction of left hand skin, external approach

0H5HXZD Destruction of right upper leg skin, multiple, external approach

0H5HXZZ Destruction of right upper leg skin, external approach

0H5JXZD Destruction of left upper leg skin, multiple, external approach

0H5JXZZ Destruction of left upper leg skin, external approach

0H5KXZD Destruction of right lower leg skin, multiple, external approach

0H5KXZZ Destruction of right lower leg skin, external approach

0H5LXZD Destruction of left lower leg skin, multiple, external approach

0H5LXZZ Destruction of left lower leg skin, external approach

0H5MXZD Destruction of right foot skin, multiple, external approach

0H5MXZZ Destruction of right foot skin, external approach

0H5NXZD Destruction of left foot skin, multiple, external approach

0H5NXZZ Destruction of left foot skin, external approach

Coding Criteria: Dermabrasion CPT/HCPCS Codes Code Description 15780 Dermabrasion total face 15781 Dermabrasion; segmental, face 15782 Dermabrasion other than face




15783 Dermabrasion superficial any site ICP/PCS Codes ICP Code Description PCS Code Description 86.25 Dermabrasion 0HD1XZZ Extraction of face skin, external

approach Coding Criteria: Dermal Injections CPT/HCPCS Codes Code Description C9800 Dermal injection procedure(s) for facial lipodystrophy syndrome (LDS) and provision of

Radiesse or Sculptra dermal filler, including all items and supplies G0429 Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (LDS) (e.g., as a

result of highly active antiretroviral therapy) Q2026 Injection, Radiesse, 0.1 ml Q2028 Injection, Sculptra, 0.5 mg ICP/PCS Codes ICP Code Description PCS Code Description 86.02 (for C9800 only)

Injection or tattooing of skin lesion or defect

3E013GC Introduction of other therapeutic substance into subcutaneous tissue, percutaneous approach

3E013GC Introduction of other therapeutic substance into subcutaneous tissue, percutaneous approach

Coding Criteria: Abdominal Lipectomy/Panniculectomy CPT/HCPCS Codes Code Description 15830 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical

panniculectomy 15847 Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (e.g.,

abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)

Anesthesia Codes ICP Code Description PCS Code Description 00802 Anesthesia for procedures on lower anterior abdominal wall; panniculectomy ICP/PCS Codes ICP Code Description PCS Code Description 86.83 Size reduction plastic operation 0W0F0ZZ Alteration of abdominal wall, open

approach 0WQF0ZZ Repair abdominal wall, open approach 0WQF0ZZ Repair abdominal wall, open approach

Coding Criteria: Myocutaneous Flaps CPT/HCPCS Codes The following CPT codes are subject to pre-payment review of coding accuracy and medical necessity and/or post-payment review of same, unless submitted with ICD V50.0, V50.1, V50.3, V50.8 or V50.9 in the primary position which will be denied as cosmetic. Code Description 15570 Formation of direct or tubed pedicle, with or without transfer; trunk




15731 Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)

15732 Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., temporalis, masseter muscle, sternocleidomastoid, levator scapulae)

15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 15736 Muscle, myocutaneous, or fasciocutaneous flap; upper extremity 15738 Muscle, myocutaneous, or fasciocutaneous flap; lower extremity 15740 Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel 15756 Free muscle or myocutaneous flap with microvascular anastomosis ICP/PCS Codes

Myocutaneious Flaps ICP-PCS Coding.pdf

Coding Criteria: Cosmetic CPT/HCPCS Codes: THE FOLLOWING CPT CODES ARE NEVER COVERED The following CPT codes are always considered cosmetic. Code Description 11950 Subcutaneous injection of filling material (e.g., collagen); 1 cc or less 11951 Subcutaneous injection of filling material (e.g., collagen); 1.1 to 5.0 cc 11952 Subcutaneous injection of filling material (e.g., collagen); 5.1 to 10.0 cc 11954 Subcutaneous injection of filling material (e.g., collagen); over 10.0 cc 15786 Abrasion; single lesion (e.g., keratosis, scar) 15787 Abrasion; each additional 4 lesions or less (list separately in addition to code for primary

procedure) 15819 Cervicoplasty 15824 Rhytidectomy; forehead 15825 Rhytidectomy; neck with platysmal tightening (platysmal flap, p-flap) 15826 Rhytidectomy; glabellar frown lines 15828 Rhytidectomy; cheek, chin, and neck 15829 Rhytidectomy; superficial musculoaponeurotic system (smas) flap 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 15876 Suction assisted lipectomy; head and neck 15878 Suction assisted lipectomy; upper extremity 15879 Suction assisted lipectomy; lower extremity




17380 Electrolysis epilation, each 30 minutes 21120 Genioplasty; augmentation (autograft, allograft, prosthetic material) 21122 Genioplasty; Sliding Osteotomies, 2 Or More Osteotomies (e.g., Wedge Excision Or Bone

Wedge Reversal For Asymmetrical Chin) 21270 Malar augmentation, prosthetic material 30120 Excision or surgical planing of skin of nose for rhinophyma 36468 Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); limb or trunk 36469 Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); face 69090 Ear piercing 69300 Otoplasty, protruding ear, with or without size reduction ICP/PCS Codes: THE FOLLOWING ICP/PCS CODES ARE NEVER COVERED

Cosmetic ICP-PCS Coding.pdf

Questions and Answers

1

Q: What does cosmetic exclusion mean? A: General Exclusions From Coverage; Cosmetic Surgery (Section 120) states:

“Cosmetic surgery or expenses incurred in connection with such surgery is not covered. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body member. For example, this exclusion does not apply to surgery in connection with treatment of severe burns or repair of the face following a serious automobile accident, or to surgery for therapeutic purposes which coincidentally also serves some cosmetic purpose.”

2 Q: Why are the blepharoplasty codes not in this policy? A: A separate policy will be developed for the blepharoplasty codes.

References Included (but not limited to): CMS NCD(s) NCD 140.2 Breast Reconstruction Following Mastectomy NCD 140.4 Plastic Surgery to Correct "Moon Face" NCD 250.4 Treatment of Actinic Keratosis NCD 250.5 Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome (LDS) CMS LCD(s) Numerous LCDs CMS Benefit Policy Manual Chapter 16; § 10 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 Claims Processing Manual Chapter 32, § 260 Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS) UnitedHealthcare Medicare Advantage Coverage Summaries Cosmetic and Reconstructive Procedures Blepharoplasty UnitedHealthcare Coverage Determination Guidelines (CDGs) Cosmetic and Reconstructive Procedures




Others Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5 Correct Coding Initiative, CMS Website Social Security Act (Title XVIII) Standard References: • § 1862 (a)(1)(A) Medically Reasonable & Necessary, (a)(10) Cosmetic Surgery • § 1833 (e) Incomplete Claim History Date Revisions 12/01/2014 Codes 15731 & 15756 were added to this policy with an effective date of 12/01/2014 04/23/2014 New policy developed and approved by MRPC

ICP Code Description PCS Code Description18.01 Piercing of ear lobe Z41.9 Encounter for procedure for purposes other than remedying

health state, unspecified18.5 Surgical correction of prominent ear Z41.9 Encounter for procedure for purposes other than remedying

health state, unspecified18.5 Surgical correction of prominent ear 8E0HXY9 Piercing of Integumentary System and Breast 18.5 Surgical correction of prominent ear 8E0HXY9 Piercing of Integumentary System and Breast 21.32 Local excision or destruction of other lesion of nose 09Q00ZZ Repair right external ear, open approach 21.32 Local excision or destruction of other lesion of nose 09Q10ZZ Repair left external ear, open approach 39.92 Injection of sclerosing agent into vein 09Q20ZZ Repair bilateral external ear, open approach39.92 Injection of sclerosing agent into vein 095KXZZ Destruction of nose, external approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 09BKXZZ Excision of nose, external approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 3E033TZ Introduction of destructive agent into peripheral vein,

percutaneous approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 3E043TZ Introduction of destructive agent into central vein,

percutaneous approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRT07Z Replacement of right mandible with autologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRT0JZ Replacement of right mandible with synthetic substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRT0KZ Replacement of right mandible with nonautologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRV07Z Replacement of left mandible with autologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRV0JZ Replacement of left mandible with synthetic substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NRV0KZ Replacement of left mandible with nonautologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUT07Z Supplement right mandible with autologous tissue substitute,

open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUT0JZ Supplement right mandible with synthetic substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUT0KZ Supplement right mandible with nonautologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUV07Z Supplement left mandible with autologous tissue substitute,

open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUV0JZ Supplement left mandible with synthetic substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0NUV0KZ Supplement left mandible with nonautologous tissue

substitute, open approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W0407Z Alteration of upper jaw with autologous tissue substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W040JZ Alteration of upper jaw with synthetic substitute, open

approach 76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W040KZ Alteration of upper jaw with nonautologous tissue substitute,

open approach76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W0507Z Alteration of lower jaw with autologous tissue substitute, open

approach

76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W050JZ Alteration of lower jaw with synthetic substitute, open approach

76.62 Open osteoplasty (osteotomy) of mandibular ramus 0W050KZ Alteration of lower jaw with nonautologous tissue substitute, open approach

76.62 Open osteoplasty (osteotomy) of mandibular ramus 0WU407Z Supplement upper jaw with autologous tissue substitute, open approach

76.62 Open osteoplasty (osteotomy) of mandibular ramus 0WU40JZ Supplement upper jaw with synthetic substitute, open approach

76.62 Open osteoplasty (osteotomy) of mandibular ramus 0WU40KZ Supplement upper jaw with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0WU507Z Supplement lower jaw with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0WU50JZ Supplement lower jaw with synthetic substitute, open approach

76.68 Augmentation genioplasty 0WU50KZ Supplement lower jaw with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NRT07Z Replacement of right mandible with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NRT0JZ Replacement of right mandible with synthetic substitute, open approach

76.68 Augmentation genioplasty 0NRT0KZ Replacement of right mandible with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NRV07Z Replacement of left mandible with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NRV0JZ Replacement of left mandible with synthetic substitute, open approach

76.68 Augmentation genioplasty 0NRV0KZ Replacement of left mandible with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NUT07Z Supplement right mandible with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NUT0JZ Supplement right mandible with synthetic substitute, open approach

76.68 Augmentation genioplasty 0NUT0KZ Supplement right mandible with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NUV07Z Supplement left mandible with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0NUV0JZ Supplement left mandible with synthetic substitute, open approach

76.68 Augmentation genioplasty 0NUV0KZ Supplement left mandible with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0W0407Z Alteration of upper jaw with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0W040JZ Alteration of upper jaw with synthetic substitute, open approach

76.68 Augmentation genioplasty 0W040KZ Alteration of upper jaw with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0W0507Z Alteration of lower jaw with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0W050JZ Alteration of lower jaw with synthetic substitute, open approach

76.68 Augmentation genioplasty 0W050KZ Alteration of lower jaw with nonautologous tissue substitute, open approach

76.68 Augmentation genioplasty 0WU407Z Supplement upper jaw with autologous tissue substitute, open approach

76.68 Augmentation genioplasty 0WU40JZ Supplement upper jaw with synthetic substitute, open approach

76.68 Augmentation genioplasty 0WU40KZ Supplement upper jaw with nonautologous tissue substitute, open approach

76.69 Other facial bone repair 0WU507Z Supplement lower jaw with autologous tissue substitute, open approach

76.69 Other facial bone repair 0WU50JZ Supplement lower jaw with synthetic substitute, open approach

76.91 Bone graft to facial bone 0WU50KZ Supplement lower jaw with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NUM0JZ Supplement right zygomatic bone with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NUN0JZ Supplement left zygomatic bone with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NRT07Z Replacement of right mandible with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NRT0JZ Replacement of right mandible with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NRT0KZ Replacement of right mandible with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NRV07Z Replacement of left mandible with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NRV0JZ Replacement of left mandible with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NRV0KZ Replacement of left mandible with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NUT07Z Supplement right mandible with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NUT0JZ Supplement right mandible with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NUT0KZ Supplement right mandible with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NUV07Z Supplement left mandible with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0NUV0JZ Supplement left mandible with synthetic substitute, open approach

76.91 Bone graft to facial bone 0NUV0KZ Supplement left mandible with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0W0407Z Alteration of upper jaw with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0W040JZ Alteration of upper jaw with synthetic substitute, open approach

76.91 Bone graft to facial bone 0W040KZ Alteration of upper jaw with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0W0507Z Alteration of lower jaw with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0W050JZ Alteration of lower jaw with synthetic substitute, open approach

76.91 Bone graft to facial bone 0W050KZ Alteration of lower jaw with nonautologous tissue substitute, open approach

76.91 Bone graft to facial bone 0WU407Z Supplement upper jaw with autologous tissue substitute, open approach

76.91 Bone graft to facial bone 0WU40JZ Supplement upper jaw with synthetic substitute, open approach

76.91 Bone graft to facial bone 0WU40KZ Supplement upper jaw with nonautologous tissue substitute, open approach

76.92 Insertion of synthetic implant in facial bone 0WU507Z Supplement lower jaw with autologous tissue substitute, open approach

76.92 Insertion of synthetic implant in facial bone 0WU50JZ Supplement lower jaw with synthetic substitute, open approach

86.25 Dermabrasion 0WU50KZ Supplement lower jaw with nonautologous tissue substitute, open approach

86.25 Dermabrasion 0NUM0JZ Supplement right zygomatic bone with synthetic substitute, open approach

86.25 Dermabrasion 0NUN0JZ Supplement left zygomatic bone with synthetic substitute, open approach

86.25 Dermabrasion 0HD1XZZ Extraction of face skin, external approach 86.25 Dermabrasion 0HD0XZZ Extraction of scalp skin, external approach 86.25 Dermabrasion 0HD4XZZ Extraction of neck skin, external approach 86.25 Dermabrasion 0HD5XZZ Extraction of chest skin, external approach 86.25 Dermabrasion 0HD6XZZ Extraction of back skin, external approach 86.25 Dermabrasion 0HD7XZZ Extraction of abdomen skin, external approach 86.25 Dermabrasion 0HD8XZZ Extraction of buttock skin, external approach 86.25 Dermabrasion 0HDAXZZ Extraction of genitalia skin, external approach 86.25 Dermabrasion 0HDBXZZ Extraction of right upper arm skin, external approach 86.25 Dermabrasion 0HDCXZZ Extraction of left upper arm skin, external approach 86.25 Dermabrasion 0HDDXZZ Extraction of right lower arm skin, external approach 86.25 Dermabrasion 0HDEXZZ Extraction of left lower arm skin, external approach 86.25 Dermabrasion 0HDFXZZ Extraction of right hand skin, external approach 86.25 Dermabrasion 0HDGXZZ Extraction of left hand skin, external approach86.25 Dermabrasion 0HDHXZZ Extraction of right upper leg skin, external approach86.25 Dermabrasion 0HDJXZZ Extraction of left upper leg skin, external approach 86.25 Dermabrasion 0HDKXZZ Extraction of right lower leg skin, external approach 86.25 Dermabrasion 0HDLXZZ Extraction of left lower leg skin, external approach 86.25 Dermabrasion 0HDMXZZ Extraction of right foot skin, external approach 86.82 Facial rhytidectomy 0HDNXZZ Extraction of left foot skin, external approach 86.82 Facial rhytidectomy 095KXZZ Destruction of nose, external approach 86.82 Facial rhytidectomy 09BKXZZ Excision of nose, external approach 86.82 Facial rhytidectomy 0J010ZZ Alteration of face subcutaneous tissue and fascia, open

approach

86.83 Size reduction plastic operation 0W020ZZ Alteration of face, open approach 86.83 Size reduction plastic operation 0W0607Z Alteration of neck with autologous tissue substitute, open

approach 86.83 Size reduction plastic operation 0W060ZZ Alteration of neck, open approach 86.83 Size reduction plastic operation 0W060ZZ Alteration of neck, open approach 86.83 Size reduction plastic operation 0J080ZZ Alteration of abdomen subcutaneous tissue and fascia, open

approach 86.83 Size reduction plastic operation 0W0F0ZZ Alteration of abdominal wall, open approach86.83 Size reduction plastic operation 0WQF0ZZ Repair abdominal wall, open approach 86.83 Size reduction plastic operation 0J0L0ZZ Alteration of right upper leg subcutaneous tissue and fascia,

open approach86.83 Size reduction plastic operation 0J0M0ZZ Alteration of left upper leg subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0Y0C0ZZ Alteration of right upper leg, open approach 86.83 Size reduction plastic operation 0Y0D0ZZ Alteration of left upper leg, open approach 86.83 Size reduction plastic operation 0Y090ZZ Alteration of right lower extremity, open approach 86.83 Size reduction plastic operation 0Y0B0ZZ Alteration of left lower extremity, open approach 86.83 Size reduction plastic operation 0Y0C0ZZ Alteration of right upper leg, open approach86.83 Size reduction plastic operation 0Y0D0ZZ Alteration of left upper leg, open approach86.83 Size reduction plastic operation 0Y0F0ZZ Alteration of right knee region, open approach 86.83 Size reduction plastic operation 0Y0G0ZZ Alteration of left knee region, open approach 86.83 Size reduction plastic operation 0Y0H0ZZ Alteration of right lower leg, open approach 86.83 Size reduction plastic operation 0Y0J0ZZ Alteration of left lower leg, open approach 86.83 Size reduction plastic operation 0Y0K0ZZ Alteration of right ankle region, open approach 86.83 Size reduction plastic operation 0Y0L0ZZ Alteration of left ankle region, open approach 86.83 Size reduction plastic operation 0J0L0ZZ Alteration of right upper leg subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J090ZZ Alteration of buttock subcutaneous tissue and fascia, open

approach 86.83 Size reduction plastic operation 0Y000ZZ Alteration of right buttock, open approach 86.83 Size reduction plastic operation 0Y010ZZ Alteration of left buttock, open approach 86.83 Size reduction plastic operation 0J0D0ZZ Alteration of right upper arm subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J0F0ZZ Alteration of left upper arm subcutaneous tissue and fascia,

open approach86.83 Size reduction plastic operation 0J0G0ZZ Alteration of right lower arm subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J0H0ZZ Alteration of left lower arm subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0X020ZZ Alteration of right shoulder region, open approach 86.83 Size reduction plastic operation 0X030ZZ Alteration of left shoulder region, open approach 86.83 Size reduction plastic operation 0X060ZZ Alteration of right upper extremity, open approach 86.83 Size reduction plastic operation 0X070ZZ Alteration of left upper extremity, open approach 86.83 Size reduction plastic operation 0X080ZZ Alteration of right upper arm, open approach 86.83 Size reduction plastic operation 0X090ZZ Alteration of left upper arm, open approach 86.83 Size reduction plastic operation 0X0B0ZZ Alteration of right elbow region, open approach 86.83 Size reduction plastic operation 0X0C0ZZ Alteration of left elbow region, open approach 86.83 Size reduction plastic operation 0X0D0ZZ Alteration of right lower arm, open approach

86.83 Size reduction plastic operation 0X0F0ZZ Alteration of left lower arm, open approach 86.83 Size reduction plastic operation 0X0G0ZZ Alteration of right wrist region, open approach 86.83 Size reduction plastic operation 0X0H0ZZ Alteration of left wrist region, open approach 86.83 Size reduction plastic operation 0J0G0ZZ Alteration of right lower arm subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J0H0ZZ Alteration of left lower arm subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0X0F0ZZ Alteration of left lower arm, open approach 86.83 Size reduction plastic operation 0X0G0ZZ Alteration of right wrist region, open approach 86.83 Size reduction plastic operation 0J040ZZ Alteration of anterior neck subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J050ZZ Alteration of posterior neck subcutaneous tissue and fascia,

open approach 86.83 Size reduction plastic operation 0J060ZZ Alteration of chest subcutaneous tissue and fascia, open

approach 86.83 Size reduction plastic operation 0J070ZZ Alteration of back subcutaneous tissue and fascia, open

approach86.83 Size reduction plastic operation 0W000ZZ Alteration of head, open approach 86.83 Size reduction plastic operation 0W020ZZ Alteration of face, open approach86.83 Size reduction plastic operation 0W040ZZ Alteration of upper jaw, open approach 86.83 Size reduction plastic operation 0W050ZZ Alteration of lower jaw, open approach 86.83 Size reduction plastic operation 0W080ZZ Alteration of chest wall, open approach 86.83 Size reduction plastic operation 0W0F0ZZ Alteration of abdominal wall, open approach 86.83 Size reduction plastic operation 0W0K0ZZ Alteration of upper back, open approach 86.83 Size reduction plastic operation 0W0L0ZZ Alteration of lower back, open approach 86.83 Size reduction plastic operation 0W0M0ZZ Alteration of male perineum, open approach 86.83 Size reduction plastic operation 0W0N0ZZ Alteration of female perineum, open approach 86.83 Size reduction plastic operation 0X040ZZ Alteration of right axilla, open approach 86.83 Size reduction plastic operation 0X050ZZ Alteration of left axilla, open approach 86.83 Size reduction plastic operation 0J013ZZ Alteration of face subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J043ZZ Alteration of anterior neck subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J053ZZ Alteration of posterior neck subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J0D3ZZ Alteration of right upper arm subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J0F3ZZ Alteration of left upper arm subcutaneous tissue and fascia,

percutaneous approach86.83 Size reduction plastic operation 0J0G3ZZ Alteration of right lower arm subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J0H3ZZ Alteration of left lower arm subcutaneous tissue and fascia,

percutaneous approach 86.83 Size reduction plastic operation 0J0L3ZZ Alteration of right upper leg subcutaneous tissue and fascia,

percutaneous approach 86.89 Other repair and reconstruction of skin and subcutaneous

tissue 0J0M3ZZ Alteration of left upper leg subcutaneous tissue and fascia,

percutaneous approach

86.89 Other repair and reconstruction of skin and subcutaneous tissue

0J0N3ZZ Alteration of right lower leg subcutaneous tissue and fascia, percutaneous approach

86.89 Other repair and reconstruction of skin and subcutaneous tissue

0J0P3ZZ Alteration of left lower leg subcutaneous tissue and fascia, percutaneous approach

86.92 Electrolysis and other epilation of skin 0W060ZZ Alteration of neck, open approach 86.99 Other operations on skin and subcutaneous tissue 0W0607Z Alteration of neck with autologous tissue substitute, open

approach

ICP Code Description PCS Code Description85.0 Mastotomy 0HNT0ZZ Release right breast, open approach 85.0 Mastotomy 0HNU0ZZ Release left breast, open approach 85.0 Mastotomy 0HNV0ZZ Release bilateral breast, open approach 85.0 Mastotomy 0HNW0ZZ Release right nipple, open approach 85.0 Mastotomy 0HNX0ZZ Release left nipple, open approach 85.0 Mastotomy 0HPT0JZ Removal of synthetic substitute from right breast, open

approach 85.0 Mastotomy 0HPU0JZ Removal of synthetic substitute from left breast, open

approach 85.21 Local excision of lesion of breast 0HNT0ZZ Release right breast, open approach 85.21 Local excision of lesion of breast 0HNU0ZZ Release left breast, open approach 85.21 Local excision of lesion of breast 0HNV0ZZ Release bilateral breast, open approach 85.21 Local excision of lesion of breast 0HNW0ZZ Release right nipple, open approach 85.21 Local excision of lesion of breast 0HNX0ZZ Release left nipple, open approach 85.21 Local excision of lesion of breast 0HPT0JZ Removal of synthetic substitute from right breast, open

approach 85.21 Local excision of lesion of breast 0HPU0JZ Removal of synthetic substitute from left breast, open

approach 85.31 Unilateral reduction mammoplasty 0H0T0ZZ Alteration of right breast, open approach 85.31 Unilateral reduction mammoplasty 0H0U0ZZ Alteration of left breast, open approach 85.31 Unilateral reduction mammoplasty 0H0V0ZZ Alteration of bilateral breast, open approach 85.31 Unilateral reduction mammoplasty 0HBT0ZZ Excision of right breast, open approach 85.31 Unilateral reduction mammoplasty 0HBU0ZZ Excision of left breast, open approach 85.31 Unilateral reduction mammoplasty 0HBV0ZZ Excision of bilateral breast, open approach 85.32 Bilateral reduction mammoplasty 0H0T0ZZ Alteration of right breast, open approach 85.32 Bilateral reduction mammoplasty 0H0U0ZZ Alteration of left breast, open approach 85.32 Bilateral reduction mammoplasty 0H0V0ZZ Alteration of bilateral breast, open approach 85.32 Bilateral reduction mammoplasty 0HBT0ZZ Excision of right breast, open approach 85.32 Bilateral reduction mammoplasty 0HBU0ZZ Excision of left breast, open approach 85.32 Bilateral reduction mammoplasty 0HBV0ZZ Excision of bilateral breast, open approach 85.42 Bilateral simple mastectomy 0HRT075 Replacement of right breast using latissimus dorsi

myocutaneous flap, open approach 85.42 Bilateral simple mastectomy 0HRU075 Replacement of left breast using latissimus dorsi

myocutaneous flap, open approach 85.42 Bilateral simple mastectomy 0HRV075 Replacement of bilateral breast using latissimus dorsi

myocutaneous flap, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0H0T0ZZ Alteration of right breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0H0U0ZZ Alteration of left breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0H0V0ZZ Alteration of bilateral breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0HQT0ZZ Repair right breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0HQU0ZZ Repair left breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0HQV0ZZ Repair bilateral breast, open approach 85.50 Augmentation mammoplasty, not otherwise specified 0H0T0JZ Alteration of right breast with synthetic substitute, open

approach

85.50 Augmentation mammoplasty, not otherwise specified 0H0U0JZ Alteration of left breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0H0V0JZ Alteration of bilateral breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HRT0JZ Replacement of right breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HRU0JZ Replacement of left breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HUT0JZ Supplement right breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HUU0JZ Supplement left breast with synthetic substitute, open approach

85.50 Augmentation mammoplasty, not otherwise specified 0HUV0JZ Supplement bilateral breast with synthetic substitute, open approach

85.53 Unilateral breast implant 0H0T0ZZ Alteration of right breast, open approach 85.53 Unilateral breast implant 0H0U0ZZ Alteration of left breast, open approach 85.53 Unilateral breast implant 0H0V0ZZ Alteration of bilateral breast, open approach 85.53 Unilateral breast implant 0HQT0ZZ Repair right breast, open approach 85.53 Unilateral breast implant 0HQU0ZZ Repair left breast, open approach 85.53 Unilateral breast implant 0HQV0ZZ Repair bilateral breast, open approach 85.53 Unilateral breast implant 0H0T0JZ Alteration of right breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0H0U0JZ Alteration of left breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0H0V0JZ Alteration of bilateral breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0HRT0JZ Replacement of right breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0HRU0JZ Replacement of left breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0HUT0JZ Supplement right breast with synthetic substitute, open

approach85.53 Unilateral breast implant 0HUU0JZ Supplement left breast with synthetic substitute, open

approach 85.53 Unilateral breast implant 0HUV0JZ Supplement bilateral breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0H0T0ZZ Alteration of right breast, open approach 85.54 Bilateral breast implant 0H0U0ZZ Alteration of left breast, open approach 85.54 Bilateral breast implant 0H0V0ZZ Alteration of bilateral breast, open approach 85.54 Bilateral breast implant 0HQT0ZZ Repair right breast, open approach 85.54 Bilateral breast implant 0HQU0ZZ Repair left breast, open approach

85.54 Bilateral breast implant 0HQV0ZZ Repair bilateral breast, open approach 85.54 Bilateral breast implant 0H0T0JZ Alteration of right breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0H0U0JZ Alteration of left breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0H0V0JZ Alteration of bilateral breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0HRT0JZ Replacement of right breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0HRU0JZ Replacement of left breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0HUT0JZ Supplement right breast with synthetic substitute, open

approach85.54 Bilateral breast implant 0HUU0JZ Supplement left breast with synthetic substitute, open

approach 85.54 Bilateral breast implant 0HUV0JZ Supplement bilateral breast with synthetic substitute, open

approach 85.55 Fat graft to breast 0HRT077 Replacement of right breast using deep inferior epigastric

artery perforator flap, open approach 85.55 Fat graft to breast 0HRT078 Replacement of right breast using superficial inferior epigastric

artery flap, open approach 85.55 Fat graft to breast 0HRT079 Replacement of right breast using gluteal artery perforator

flap, open approach 85.55 Fat graft to breast 0HRT07Z Replacement of right breast with autologous tissue substitute,

open approach 85.55 Fat graft to breast 0HRT0JZ Replacement of right breast with synthetic substitute, open

approach 85.55 Fat graft to breast 0HRT0KZ Replacement of right breast with nonautologous tissue

substitute, open approach 85.55 Fat graft to breast 0HRU077 Replacement of left breast using deep inferior epigastric artery

perforator flap, open approach 85.55 Fat graft to breast 0HRU078 Replacement of left breast using superficial inferior epigastric

artery flap, open approach 85.55 Fat graft to breast 0HRU079 Replacement of left breast using gluteal artery perforator flap,

open approach 85.55 Fat graft to breast 0HRU07Z Replacement of left breast with autologous tissue substitute,

open approach85.55 Fat graft to breast 0HRU0JZ Replacement of left breast with synthetic substitute, open

approach 85.55 Fat graft to breast 0HRU0KZ Replacement of left breast with nonautologous tissue

substitute, open approach 85.55 Fat graft to breast 0HRV077 Replacement of bilateral breast using deep inferior epigastric

artery perforator flap, open approach

85.55 Fat graft to breast 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.55 Fat graft to breast 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.55 Fat graft to breast 0HRV07Z Replacement of bilateral breast with autologous tissue substitute, open approach

85.55 Fat graft to breast 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open approach

85.55 Fat graft to breast 0HRV0KZ Replacement of bilateral breast with nonautologous tissue substitute, open approach

85.6 Mastopexy 0HQT0ZZ Repair right breast, open approach 85.6 Mastopexy 0HQU0ZZ Repair left breast, open approach 85.6 Mastopexy 0HQV0ZZ Repair bilateral breast, open approach 85.6 Mastopexy 0HST0ZZ Reposition right breast, open approach 85.6 Mastopexy 0HSU0ZZ Reposition left breast, open approach 85.6 Mastopexy 0HSV0ZZ Reposition bilateral breast, open approach 85.6 Mastopexy 0HSWXZZ Reposition right nipple, external approach 85.6 Mastopexy 0HSXXZZ Reposition left nipple, external approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT077 Replacement of right breast using deep inferior epigastric

artery perforator flap, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT078 Replacement of right breast using superficial inferior epigastric

artery flap, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT079 Replacement of right breast using gluteal artery perforator

flap, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT07Z Replacement of right breast with autologous tissue substitute,

open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT0JZ Replacement of right breast with synthetic substitute, open

approach 85.70 Total reconstruction of breast, not otherwise specified 0HRT0KZ Replacement of right breast with nonautologous tissue

substitute, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRU077 Replacement of left breast using deep inferior epigastric artery

perforator flap, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRU078 Replacement of left breast using superficial inferior epigastric

artery flap, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRU079 Replacement of left breast using gluteal artery perforator flap,

open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRU07Z Replacement of left breast with autologous tissue substitute,

open approach85.70 Total reconstruction of breast, not otherwise specified 0HRU0JZ Replacement of left breast with synthetic substitute, open

approach 85.70 Total reconstruction of breast, not otherwise specified 0HRU0KZ Replacement of left breast with nonautologous tissue

substitute, open approach 85.70 Total reconstruction of breast, not otherwise specified 0HRV077 Replacement of bilateral breast using deep inferior epigastric

artery perforator flap, open approach

85.70 Total reconstruction of breast, not otherwise specified 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.70 Total reconstruction of breast, not otherwise specified 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.70 Total reconstruction of breast, not otherwise specified 0HRV07Z Replacement of bilateral breast with autologous tissue substitute, open approach

85.70 Total reconstruction of breast, not otherwise specified 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open approach

85.70 Total reconstruction of breast, not otherwise specified 0HRV0KZ Replacement of bilateral breast with nonautologous tissue substitute, open approach

85.71 Latissimus dorsi myocutaneous flap 0HRT075 Replacement of right breast using latissimus dorsi myocutaneous flap, open approach

85.71 Latissimus dorsi myocutaneous flap 0HRU075 Replacement of left breast using latissimus dorsi myocutaneous flap, open approach

85.71 Latissimus dorsi myocutaneous flap 0HRV075 Replacement of bilateral breast using latissimus dorsi myocutaneous flap, open approach

85.72 Transverse rectus abdominis myocutaneous (TRAM) flap, pedicled

0HRT076 Replacement of right breast using transverse rectus abdominis myocutaneous flap, open approach


0HRU076 Replacement of left breast using transverse rectus abdominis myocutaneous flap, open approach


0HRV076 Replacement of bilateral breast using transverse rectus abdominis myocutaneous flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRT076 Replacement of right breast using transverse rectus abdominis myocutaneous flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRT07 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRU076 Replacement of left breast using transverse rectus abdominis myocutaneous flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRV076 Replacement of bilateral breast using transverse rectus abdominis myocutaneous flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.73 Transverse rectus abdominis myocutaneous (TRAM) flap, free 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRT076 Replacement of right breast using transverse rectus abdominis myocutaneous flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRT078 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRU076 Replacement of left breast using transverse rectus abdominis myocutaneous flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRV076 Replacement of bilateral breast using transverse rectus abdominis myocutaneous flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.74 Deep inferior epigastric artery perforator (DIEP) flap, free 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRT076 Replacement of right breast using transverse rectus abdominis myocutaneous flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRT078 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRU076 Replacement of left breast using transverse rectus abdominis myocutaneous flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRV076 Replacement of bilateral breast using transverse rectus abdominis myocutaneous flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.75 Superficial inferior epigastric artery (SIEA) flap, free 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRT076 Replacement of right breast using transverse rectus abdominis myocutaneous flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRT078 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRU076 Replacement of left breast using transverse rectus abdominis myocutaneous flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRV076 Replacement of bilateral breast using transverse rectus abdominis myocutaneous flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.76 Gluteal artery perforator (GAP) flap, free 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRT078 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.79 Other total reconstruction of breast 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRT07Z Replacement of right breast with autologous tissue substitute, open approach

85.79 Other total reconstruction of breast 0HRT0JZ Replacement of right breast with synthetic substitute, open approach

85.79 Other total reconstruction of breast 0HRT0KZ Replacement of right breast with nonautologous tissue substitute, open approach

85.79 Other total reconstruction of breast 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.79 Other total reconstruction of breast 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRU07Z Replacement of left breast with autologous tissue substitute, open approach

85.79 Other total reconstruction of breast 0HRU0JZ Replacement of left breast with synthetic substitute, open approach

85.79 Other total reconstruction of breast 0HRU0KZ Replacement of left breast with nonautologous tissue substitute, open approach

85.79 Other total reconstruction of breast 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.79 Other total reconstruction of breast 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.79 Other total reconstruction of breast 0HRV07Z Replacement of bilateral breast with autologous tissue substitute, open approach

85.79 Other total reconstruction of breast 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open approach

85.79 Other total reconstruction of breast 0HRV0KZ Replacement of bilateral breast with nonautologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRT077 Replacement of right breast using deep inferior epigastric artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRT078 Replacement of right breast using superficial inferior epigastric artery flap, open approach

85.85 Muscle flap graft to breast 0HRT079 Replacement of right breast using gluteal artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRT07Z Replacement of right breast with autologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRT0JZ Replacement of right breast with synthetic substitute, open approach

85.85 Muscle flap graft to breast 0HRT0KZ Replacement of right breast with nonautologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRU077 Replacement of left breast using deep inferior epigastric artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRU078 Replacement of left breast using superficial inferior epigastric artery flap, open approach

85.85 Muscle flap graft to breast 0HRU079 Replacement of left breast using gluteal artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRU07Z Replacement of left breast with autologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRU0JZ Replacement of left breast with synthetic substitute, open approach

85.85 Muscle flap graft to breast 0HRU0KZ Replacement of left breast with nonautologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRV077 Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRV078 Replacement of bilateral breast using superficial inferior epigastric artery flap, open approach

85.85 Muscle flap graft to breast 0HRV079 Replacement of bilateral breast using gluteal artery perforator flap, open approach

85.85 Muscle flap graft to breast 0HRV07Z Replacement of bilateral breast with autologous tissue substitute, open approach

85.85 Muscle flap graft to breast 0HRV0JZ Replacement of bilateral breast with synthetic substitute, open approach

85.85 Muscle flap graft to breast 0HRV0KZ Replacement of bilateral breast with nonautologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRT07Z Replacement of right breast with autologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRU07Z Replacement of left breast with autologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRV07Z Replacement of bilateral breast with autologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRW07Z Replacement of right nipple with autologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRWX7Z Replacement of right nipple with autologous tissue substitute, external approach

85.87 Other repair or reconstruction of nipple 0HRX07Z Replacement of left nipple with autologous tissue substitute, open approach

85.87 Other repair or reconstruction of nipple 0HRXX7Z Replacement of left nipple with autologous tissue substitute, external approach

85.87 Other repair or reconstruction of nipple 0HBW0ZZ Excision of right nipple, open approach 85.87 Other repair or reconstruction of nipple 0HBX0ZZ Excision of left nipple, open approach 85.87 Other repair or reconstruction of nipple 0HNW0ZZ Release right nipple, open approach 85.87 Other repair or reconstruction of nipple 0HNWXZZ Release right nipple, external approach 85.87 Other repair or reconstruction of nipple 0HNX0ZZ Release left nipple, open approach85.87 Other repair or reconstruction of nipple 0HNXXZZ Release left nipple, external approach 85.87 Other repair or reconstruction of nipple 0HQW0ZZ Repair right nipple, open approach 85.87 Other repair or reconstruction of nipple 0HQX0ZZ Repair left nipple, open approach85.93 Revision of implant of breast 0HBT0ZZ Excision of right breast, open approach85.93 Revision of implant of breast 0HBU0ZZ Excision of left breast, open approach 85.93 Revision of implant of breast 0HQT0ZZ Repair right breast, open approach 85.93 Revision of implant of breast 0HQU0ZZ Repair left breast, open approach85.93 Revision of implant of breast 0HQW0ZZ Repair right nipple, open approach85.93 Revision of implant of breast 0HQX0ZZ Repair left nipple, open approach85.93 Revision of implant of breast 0HWT0JZ Revision of synthetic substitute in right breast, open approach

85.93 Revision of implant of breast 0HWU0JZ Revision of synthetic substitute in left breast, open approach

85.95 Insertion of breast tissue expander 0HHT0NZ Insertion of tissue expander into right breast, open approach

85.95 Insertion of breast tissue expander 0HHU0NZ Insertion of tissue expander into left breast, open approach

85.95 Insertion of breast tissue expander 0HHV0NZ Insertion of tissue expander into bilateral breast, open approach

85.95 Insertion of breast tissue expander F0DZ8UZ Prosthesis device fitting using prosthesis

ICP Code Description PCS Code Description18.71 Construction of auricle of ear 0KX00Z0 Transfer head muscle with skin, open approach 18.71 Construction of auricle of ear 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 18.71 Construction of auricle of ear 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 18.71 Construction of auricle of ear 0KX00ZZ Transfer head muscle, open approach 18.71 Construction of auricle of ear 0KX10Z0 Transfer facial muscle with skin, open approach 18.71 Construction of auricle of ear 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 18.71 Construction of auricle of ear 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 18.71 Construction of auricle of ear 0KX10ZZ Transfer facial muscle, open approach 18.71 Construction of auricle of ear 0KX20Z0 Transfer right neck muscle with skin, open approach 18.71 Construction of auricle of ear 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 18.71 Construction of auricle of ear 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 18.71 Construction of auricle of ear 0KX20ZZ Transfer right neck muscle, open approach 18.71 Construction of auricle of ear 0KX30Z0 Transfer left neck muscle with skin, open approach 18.71 Construction of auricle of ear 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open

approach 18.71 Construction of auricle of ear 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue,

open approach 18.79 Other plastic repair of external ear 0KX30ZZ Transfer left neck muscle, open approach 18.79 Other plastic repair of external ear 0KX00Z0 Transfer head muscle with skin, open approach 18.79 Other plastic repair of external ear 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 18.79 Other plastic repair of external ear 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 18.79 Other plastic repair of external ear 0KX00ZZ Transfer head muscle, open approach 18.79 Other plastic repair of external ear 0KX10Z0 Transfer facial muscle with skin, open approach 18.79 Other plastic repair of external ear 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 18.79 Other plastic repair of external ear 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 18.79 Other plastic repair of external ear 0KX10ZZ Transfer facial muscle, open approach 18.79 Other plastic repair of external ear 0KX20Z0 Transfer right neck muscle with skin, open approach 18.79 Other plastic repair of external ear 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 18.79 Other plastic repair of external ear 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 18.79 Other plastic repair of external ear 0KX20ZZ Transfer right neck muscle, open approach 18.79 Other plastic repair of external ear 0KX30Z0 Transfer left neck muscle with skin, open approach 18.79 Other plastic repair of external ear 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open

approach 18.79 Other plastic repair of external ear 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue,

open approach

27.57 Attachment of pedicle or flap graft to lip and mouth 0KX30ZZ Transfer left neck muscle, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX00Z0 Transfer head muscle with skin, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX00ZZ Transfer head muscle, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX10Z0 Transfer facial muscle with skin, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX10ZZ Transfer facial muscle, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX20Z0 Transfer right neck muscle with skin, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX20ZZ Transfer right neck muscle, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX30Z0 Transfer left neck muscle with skin, open approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open

approach 27.57 Attachment of pedicle or flap graft to lip and mouth 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KX30ZZ Transfer left neck muscle, open approach 83.82 Graft of muscle or fascia 0KX00Z0 Transfer head muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX00ZZ Transfer head muscle, open approach 83.82 Graft of muscle or fascia 0KX10Z0 Transfer facial muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KX10ZZ Transfer facial muscle, open approach 83.82 Graft of muscle or fascia 0KX20Z0 Transfer right neck muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KX20ZZ Transfer right neck muscle, open approach 83.82 Graft of muscle or fascia 0KX30Z0 Transfer left neck muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue,

open approach

83.82 Graft of muscle or fascia 0KX30ZZ Transfer left neck muscle, open approach 83.82 Graft of muscle or fascia 0KXF0Z0 Transfer right trunk muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXF0Z1 Transfer right trunk muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXF0Z2 Transfer right trunk muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXF0ZZ Transfer right trunk muscle, open approach 83.82 Graft of muscle or fascia 0KXG0Z0 Transfer left trunk muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXG0Z1 Transfer left trunk muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXG0Z2 Transfer left trunk muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXG0ZZ Transfer left trunk muscle, open approach 83.82 Graft of muscle or fascia 0KXH0Z0 Transfer right thorax muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXH0Z1 Transfer right thorax muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXH0Z2 Transfer right thorax muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXJ0Z0 Transfer left thorax muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXJ0Z1 Transfer left thorax muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXJ0Z2 Transfer left thorax muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXK0Z0 Transfer right abdomen muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXK0Z1 Transfer right abdomen muscle with subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXK0Z2 Transfer right abdomen muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXK0ZZ Transfer right abdomen muscle, open approach 83.82 Graft of muscle or fascia 0KXL0Z0 Transfer left abdomen muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXL0Z1 Transfer left abdomen muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXL0Z2 Transfer left abdomen muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXL0ZZ Transfer left abdomen muscle, open approach 83.82 Graft of muscle or fascia 0KX50Z0 Transfer right shoulder muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX50Z1 Transfer right shoulder muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX50Z2 Transfer right shoulder muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KX50ZZ Transfer right shoulder muscle, open approach 83.82 Graft of muscle or fascia 0KX60Z0 Transfer left shoulder muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX60Z1 Transfer left shoulder muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KX60Z2 Transfer left shoulder muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KX60ZZ Transfer left shoulder muscle, open approach 83.82 Graft of muscle or fascia 0KX70Z0 Transfer right upper arm muscle with skin, open approach

83.82 Graft of muscle or fascia 0KX70Z1 Transfer right upper arm muscle with subcutaneous tissue, open approach

83.82 Graft of muscle or fascia 0KX70Z2 Transfer right upper arm muscle with skin and subcutaneous tissue, open approach

83.82 Graft of muscle or fascia 0KX70ZZ Transfer right upper arm muscle, open approach 83.82 Graft of muscle or fascia 0KX80Z0 Transfer left upper arm muscle with skin, open approach 83.82 Graft of muscle or fascia 0KX80Z1 Transfer left upper arm muscle with subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KX80Z2 Transfer left upper arm muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KX80ZZ Transfer left upper arm muscle, open approach 83.82 Graft of muscle or fascia 0KX90Z0 Transfer right lower arm and wrist muscle with skin, open

approach 83.82 Graft of muscle or fascia 0KX90Z1 Transfer right lower arm and wrist muscle with subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KX90Z2 Transfer right lower arm and wrist muscle with skin and

subcutaneous tissue, open approach 83.82 Graft of muscle or fascia 0KX90ZZ Transfer right lower arm and wrist muscle, open approach

83.82 Graft of muscle or fascia 0KXB0Z0 Transfer left lower arm and wrist muscle with skin, open approach

83.82 Graft of muscle or fascia 0KXB0Z1 Transfer left lower arm and wrist muscle with subcutaneous tissue, open approach

83.82 Graft of muscle or fascia 0KXB0Z2 Transfer left lower arm and wrist muscle with skin and subcutaneous tissue, open approach

83.82 Graft of muscle or fascia 0KXB0ZZ Transfer left lower arm and wrist muscle, open approach 83.82 Graft of muscle or fascia 0KXN0Z0 Transfer right hip muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXN0Z1 Transfer right hip muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXN0Z2 Transfer right hip muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXN0ZZ Transfer right hip muscle, open approach 83.82 Graft of muscle or fascia 0KXP0Z0 Transfer left hip muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXP0Z1 Transfer left hip muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXP0Z2 Transfer left hip muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXP0ZZ Transfer left hip muscle, open approach 83.82 Graft of muscle or fascia 0KXQ0Z0 Transfer right upper leg muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXQ0Z1 Transfer right upper leg muscle with subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXQ0Z2 Transfer right upper leg muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXQ0ZZ Transfer right upper leg muscle, open approach 83.82 Graft of muscle or fascia 0KXR0Z0 Transfer left upper leg muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXR0Z1 Transfer left upper leg muscle with subcutaneous tissue, open

approach

83.82 Graft of muscle or fascia 0KXR0Z2 Transfer left upper leg muscle with skin and subcutaneous tissue, open approach

83.82 Graft of muscle or fascia 0KXR0ZZ Transfer left upper leg muscle, open approach 83.82 Graft of muscle or fascia 0KXS0Z0 Transfer right lower leg muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXS0Z1 Transfer right lower leg muscle with subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXS0Z2 Transfer right lower leg muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXS0ZZ Transfer right lower leg muscle, open approach 83.82 Graft of muscle or fascia 0KXT0Z0 Transfer left lower leg muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXT0Z1 Transfer left lower leg muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXT0Z2 Transfer left lower leg muscle with skin and subcutaneous

tissue, open approach 83.82 Graft of muscle or fascia 0KXT0ZZ Transfer left lower leg muscle, open approach 83.82 Graft of muscle or fascia 0KXV0Z0 Transfer right foot muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXV0Z1 Transfer right foot muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXV0Z2 Transfer right foot muscle with skin and subcutaneous tissue,

open approach 83.82 Graft of muscle or fascia 0KXV0ZZ Transfer right foot muscle, open approach 83.82 Graft of muscle or fascia 0KXW0Z0 Transfer left foot muscle with skin, open approach 83.82 Graft of muscle or fascia 0KXW0Z1 Transfer left foot muscle with subcutaneous tissue, open

approach 83.82 Graft of muscle or fascia 0KXW0Z2 Transfer left foot muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXW0ZZ Transfer left foot muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX00Z0 Transfer head muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX00ZZ Transfer head muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX10Z0 Transfer facial muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX10ZZ Transfer facial muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX20Z0 Transfer right neck muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX20ZZ Transfer right neck muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX30Z0 Transfer left neck muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open

approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KX30ZZ Transfer left neck muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXF0Z0 Transfer right trunk muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXF0Z1 Transfer right trunk muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXF0Z2 Transfer right trunk muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXF0ZZ Transfer right trunk muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXG0Z0 Transfer left trunk muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXG0Z1 Transfer left trunk muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXG0Z2 Transfer left trunk muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXG0ZZ Transfer left trunk muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXH0Z0 Transfer right thorax muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXH0Z1 Transfer right thorax muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXH0Z2 Transfer right thorax muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXJ0Z0 Transfer left thorax muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXJ0Z1 Transfer left thorax muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXJ0Z2 Transfer left thorax muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXK0Z0 Transfer right abdomen muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXK0Z1 Transfer right abdomen muscle with subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXK0Z2 Transfer right abdomen muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXK0ZZ Transfer right abdomen muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXL0Z0 Transfer left abdomen muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXL0Z1 Transfer left abdomen muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXL0Z2 Transfer left abdomen muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXL0ZZ Transfer left abdomen muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX50Z0 Transfer right shoulder muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX50Z1 Transfer right shoulder muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX50Z2 Transfer right shoulder muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX50ZZ Transfer right shoulder muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX60Z0 Transfer left shoulder muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX60Z1 Transfer left shoulder muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX60Z2 Transfer left shoulder muscle with skin and subcutaneous

tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KX60ZZ Transfer left shoulder muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX70Z0 Transfer right upper arm muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX70Z1 Transfer right upper arm muscle with subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX70Z2 Transfer right upper arm muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX70ZZ Transfer right upper arm muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX80Z0 Transfer left upper arm muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX80Z1 Transfer left upper arm muscle with subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX80Z2 Transfer left upper arm muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX80ZZ Transfer left upper arm muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX90Z0 Transfer right lower arm and wrist muscle with skin, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX90Z1 Transfer right lower arm and wrist muscle with subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX90Z2 Transfer right lower arm and wrist muscle with skin and

subcutaneous tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KX90ZZ Transfer right lower arm and wrist muscle, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXB0Z0 Transfer left lower arm and wrist muscle with skin, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXB0Z1 Transfer left lower arm and wrist muscle with subcutaneous tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXB0Z2 Transfer left lower arm and wrist muscle with skin and subcutaneous tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXB0ZZ Transfer left lower arm and wrist muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXN0Z0 Transfer right hip muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXN0Z1 Transfer right hip muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXN0Z2 Transfer right hip muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXN0ZZ Transfer right hip muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXP0Z0 Transfer left hip muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXP0Z1 Transfer left hip muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXP0Z2 Transfer left hip muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXP0ZZ Transfer left hip muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXQ0Z0 Transfer right upper leg muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXQ0Z1 Transfer right upper leg muscle with subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXQ0Z2 Transfer right upper leg muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXQ0ZZ Transfer right upper leg muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXR0Z0 Transfer left upper leg muscle with skin, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXR0Z1 Transfer left upper leg muscle with subcutaneous tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXR0Z2 Transfer left upper leg muscle with skin and subcutaneous tissue, open approach

86.71 Cutting and preparation of pedicle grafts or flaps 0KXR0ZZ Transfer left upper leg muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXS0Z0 Transfer right lower leg muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXS0Z1 Transfer right lower leg muscle with subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXS0Z2 Transfer right lower leg muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXS0ZZ Transfer right lower leg muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXT0Z0 Transfer left lower leg muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXT0Z1 Transfer left lower leg muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXT0Z2 Transfer left lower leg muscle with skin and subcutaneous

tissue, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXT0ZZ Transfer left lower leg muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXV0Z0 Transfer right foot muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXV0Z1 Transfer right foot muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXV0Z2 Transfer right foot muscle with skin and subcutaneous tissue,

open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXV0ZZ Transfer right foot muscle, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXW0Z0 Transfer left foot muscle with skin, open approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXW0Z1 Transfer left foot muscle with subcutaneous tissue, open

approach 86.71 Cutting and preparation of pedicle grafts or flaps 0KXW0Z2 Transfer left foot muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXW0ZZ Transfer left foot muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX00Z0 Transfer head muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX00Z1 Transfer head muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX00Z2 Transfer head muscle with skin and subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX00ZZ Transfer head muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX10Z0 Transfer facial muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX10Z1 Transfer facial muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX10Z2 Transfer facial muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX10ZZ Transfer facial muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX20Z0 Transfer right neck muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX20Z1 Transfer right neck muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX20Z2 Transfer right neck muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX20ZZ Transfer right neck muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX30Z0 Transfer left neck muscle with skin, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KX30Z1 Transfer left neck muscle with subcutaneous tissue, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KX30Z2 Transfer left neck muscle with skin and subcutaneous tissue, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KX30ZZ Transfer left neck muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXF0Z0 Transfer right trunk muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXF0Z1 Transfer right trunk muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXF0Z2 Transfer right trunk muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXF0ZZ Transfer right trunk muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXG0Z0 Transfer left trunk muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXG0Z1 Transfer left trunk muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXG0Z2 Transfer left trunk muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXG0ZZ Transfer left trunk muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXH0Z0 Transfer right thorax muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXH0Z1 Transfer right thorax muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXH0Z2 Transfer right thorax muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXJ0Z0 Transfer left thorax muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXJ0Z1 Transfer left thorax muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXJ0Z2 Transfer left thorax muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXK0Z0 Transfer right abdomen muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXK0Z1 Transfer right abdomen muscle with subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXK0Z2 Transfer right abdomen muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXK0ZZ Transfer right abdomen muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXL0Z0 Transfer left abdomen muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXL0Z1 Transfer left abdomen muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXL0Z2 Transfer left abdomen muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXL0ZZ Transfer left abdomen muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX50Z0 Transfer right shoulder muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX50Z1 Transfer right shoulder muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX50Z2 Transfer right shoulder muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX50ZZ Transfer right shoulder muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX60Z0 Transfer left shoulder muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX60Z1 Transfer left shoulder muscle with subcutaneous tissue, open

approach

86.74 Attachment of pedicle or flap graft to other sites 0KX60Z2 Transfer left shoulder muscle with skin and subcutaneous tissue, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KX60ZZ Transfer left shoulder muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX70Z0 Transfer right upper arm muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX70Z1 Transfer right upper arm muscle with subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX70Z2 Transfer right upper arm muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX70ZZ Transfer right upper arm muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX80Z0 Transfer left upper arm muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX80Z1 Transfer left upper arm muscle with subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX80Z2 Transfer left upper arm muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX80ZZ Transfer left upper arm muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX90Z0 Transfer right lower arm and wrist muscle with skin, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KX90Z1 Transfer right lower arm and wrist muscle with subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX90Z2 Transfer right lower arm and wrist muscle with skin and

subcutaneous tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KX90ZZ Transfer right lower arm and wrist muscle, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KXB0Z0 Transfer left lower arm and wrist muscle with skin, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KXB0Z1 Transfer left lower arm and wrist muscle with subcutaneous tissue, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KXB0Z2 Transfer left lower arm and wrist muscle with skin and subcutaneous tissue, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KXB0ZZ Transfer left lower arm and wrist muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXN0Z0 Transfer right hip muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXN0Z1 Transfer right hip muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXN0Z2 Transfer right hip muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXN0ZZ Transfer right hip muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXP0Z0 Transfer left hip muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXP0Z1 Transfer left hip muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXP0Z2 Transfer left hip muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXP0ZZ Transfer left hip muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXQ0Z0 Transfer right upper leg muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXQ0Z1 Transfer right upper leg muscle with subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXQ0Z2 Transfer right upper leg muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXQ0ZZ Transfer right upper leg muscle, open approach

86.74 Attachment of pedicle or flap graft to other sites 0KXR0Z0 Transfer left upper leg muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXR0Z1 Transfer left upper leg muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXR0Z2 Transfer left upper leg muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXR0ZZ Transfer left upper leg muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXS0Z0 Transfer right lower leg muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXS0Z1 Transfer right lower leg muscle with subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXS0Z2 Transfer right lower leg muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXS0ZZ Transfer right lower leg muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXT0Z0 Transfer left lower leg muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXT0Z1 Transfer left lower leg muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXT0Z2 Transfer left lower leg muscle with skin and subcutaneous

tissue, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXT0ZZ Transfer left lower leg muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXV0Z0 Transfer right foot muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXV0Z1 Transfer right foot muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXV0Z2 Transfer right foot muscle with skin and subcutaneous tissue,

open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXV0ZZ Transfer right foot muscle, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXW0Z0 Transfer left foot muscle with skin, open approach 86.74 Attachment of pedicle or flap graft to other sites 0KXW0Z1 Transfer left foot muscle with subcutaneous tissue, open

approach 86.74 Attachment of pedicle or flap graft to other sites 0KXW0Z2 Transfer left foot muscle with skin and subcutaneous tissue,

open approach

Reimbursement Policy Cosmetic and … and Reconstructive Services and ... • Cosmetic surgery to...

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Transcript of Reimbursement Policy Cosmetic and … and Reconstructive Services and ... • Cosmetic surgery to...