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ICD-10-CM S21.009S, Unspecified open wound of unspecified breast, sequela | No Prior Auth

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`S21.009S`, Unspecified open wound of unspecified breast, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Removal of implantspartially or completely filledwithSilicone Gelis consideredmedically necessarywhen there is documented implant rupture (that is, using mammography, ultrasound, or MRI).
Removal of aSilicone Gel filled,Saline filled or Alternativeâimplant is consideredmedically necessaryfor any of the following:
Infection of the implant or surrounding tissue;or
Implant exposure/extrusion;or
Pain related to Baker Class IV capsular contracture;or
Confirmed cases of breast implant-associated anaplastic large cell lymphoma;or

1 Active Policy

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

Related Codes

11921(1 policies)11922(1 policies)15877(1 policies)17999(1 policies)19316(1 policies)19318(1 policies)19324(1 policies)11920(1 policies)

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