Billing and Coding: Reduction Mammaplasty

This billing and coding guidance requires adherence to the related LCD for clinical coverage of reduction mammaplasty and mandates that each claim include valid ICD-10-CM diagnosis code(s) that reflect the patient's condition. Claims must include referring/ordering physician name and NPI when required, comply with NCCI/OPPS coding edits, and be supported by medical-record documentation (history, physical exam, and diagnostic results) available to Medicare upon request.

"Follow the related Local Coverage Determination (LCD) for clinical indications and medical necessity criteria for reduction mammaplasty."

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