Does S2068 require prior authorization?

No, S2068 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S2068?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`S2068` — Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage; medical records documentation used for reviews (general statement from policy).
Documentation of prior Mastectomy (operative report, pathology report, or other clinical record) to support reconstruction related to Mastectomy and WHCRA entitlement.

For treatment of lymphedema and related services, documentation of lymphedema diagnosis (e.g., I97.2 Postmastectomy lymphedema syndrome) and records supporting prescribed therapy (e.g., orders/therapy notes for complex decongestive physiotherapy, DME orders for lymphedema pumps, prescriptions/fit notes for compression sleeves, documentation of elastic bandages/wraps associated with medical treatment).

Key Coverage Criteria

Treatment for post-mastectomy complications including postoperative infection(s).
Breast reconstruction after Mastectomy with or without a diagnosis of cancer in accordance with the Women's Health and Cancer Rights Act of 1998 (reconstruction of the breast on which the Mastectomy was performed).
Surgery and reconstruction of the contralateral breast to produce a symmetrical appearance, including nipple tattooing (per WHCRA).
Prostheses (implanted and/or external) related to breast reconstruction post-mastectomy (per WHCRA).
Treatment of physical complications of Mastectomy, including lymphedema (including complex decongestive physiotherapy (CDP), lymphedema pumps [considered durable medical equipment], compression lymphedema sleeves [considered a prosthetic device], elastic bandages and wraps associated with medically necessary treatments for complications of lymphedema).
Breast reconstruction during or post Mastectomy and reconstruction for treatment of congenital disorder (e.g., Poland syndrome, Turner syndrome) or severe breast disfigurement (e.g., amastia, radiation) when considered reconstructive and medically necessary in accordance with InterQual CP: Procedures, Breast Reconstruction.

10 Active Policies

ANTHEM-SURG.00023 — SURG.00023 Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures

UHC-POL-breast-reconstruction — Breast Reconstruction

UMR-POL-UMR-breast-reconstruction — Breast Reconstruction

SUREST-POL-SUREST-breast-reconstruction — Breast Reconstruction

BCBSIL-SUR716.011 — Reconstructive Breast Surgery

BCBSMT-SUR716.011 — Reconstructive Breast Surgery

BCBSNM-SUR716.011 — Reconstructive Breast Surgery

BCBSOK-SUR716.011 — Reconstructive Breast Surgery

REGENCE-SUR40 — Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants

SUR716.011 — Reconstructive Breast Surgery

`S2068` — Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

S2068 — Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

`S2068` — Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral