Prior Auth Required

19370 - Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceRevision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 19357 Tissue expander placement in breast reconstruction, including subsequent expansion(s) 19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) 19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy 19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents

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  • Submit clinical notes if requested by the plan
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