Prior Auth Required

19364 - Surgical - Breast Breast reconstruction with free flap (eg, fTRAM

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceSurgical - Breast Breast reconstruction with free flap (eg, fTRAM
Procedure / Service Description

Mountain Health Co-Op, Services Requiring Prior Authorization 4 - Surgical - Breast 19361 Breast reconstruction with latissimus dorsi flap Surgical - Breast 19364 Breast reconstruction with free flap (eg, fTRAM, DIEP, SIEA, GAP flap)

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.