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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, unilat...

HCPCS code

Medical Policies and Guidelines for 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, unilat...

Related policies from health plans

Breast Reconstruction Following Mastectomy or Lumpectomy - (0178)

Similar Codes


ICD10CM codes

Z42.1 - Encounter for breast reconstruction following mastectomy
S20.109S - Unspecified superficial injuries of breast, unspecified breast, sequela
N65.0 - Deformity of reconstructed breast
S21.029S - Laceration with foreign body of unspecified breast, sequela
S20.102S - Unspecified superficial injuries of breast, left breast, sequela
S21.009S - Unspecified open wound of unspecified breast, sequela
S20.10 - Unspecified superficial injuries of breast
S31.602S - Unspecified open wound of abdominal wall, epigastric region with penetration into peritoneal cavity,
S21.002S - Unspecified open wound of left breast, sequela
S31.622S - Laceration with foreign body of abdominal wall, epigastric region with penetration into peritoneal c

HCPCS codes

S2068 - Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior e
L8010 - Breast prosthesis, mastectomy sleeve
D4273 - SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES
C1789 - Prosthesis, breast (implantable)
G8876 - Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer pr
C5276 - Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, ge
C9605 - Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mam
C1768 - Graft, vascular
G8875 - Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
L8015 - External breast prosthesis garment, with mastectomy form, post mastectomy

CPT4 codes

19364 - Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap)
19368 - Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, re
19367 - Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap
19361 - Breast reconstruction; with latissimus dorsi flap
19380 - Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset
19366 - Breast reconstruction with other technique
49904 - Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)
49900 - Suture, secondary, of abdominal wall for evisceration or dehiscence
15757 - Free skin flap with microvascular anastomosis
39561 - Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap)