Pectus Excavatum and Poland's Syndrome: Surgical Correction

Covered: surgical repair of severe pectus excavatum and reconstruction for Poland’s syndrome are covered when they cause functional impairment; the magnetic mini-mover, vacuum bell, Dynamic Compression System, bracing or surgery for pectus carinatum (ICD-10 Q67.7), and other unlisted procedures are experimental/investigational or cosmetic and not covered. Key requirements for pectus excavatum: documented complications from the sternal deformity (e.g., cardiac compression with decreased output on echocardiography, TLC ≤80% predicted, or exercise PFTs showing reduced capacity), chest CT pectus index >3.25, and ECG/echocardiogram if a heart murmur or known heart disease is present.

"Other procedures/interventions not listed as covered (for example the Dynamic Compression System and Vacuum bell) have no specific code listed and are categorized as experimental/investigational (n..."