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Free Flap Breast Reconstruction Reimbursement Policy to be Implemented

Effective November 15, 2021, Horizon will change how we consider and reimburse certain professional claims based on our new reimbursement policy Free Flap Breast Reconstruction,

Per these policy guidelines, claims submitted for free flap (microvascular) breast reconstructive services provided on and after November 15, 2021, must include CPT ® code 19364 and all appropriate coding modifiers (-LT, -RT, -50, -62, -80, -81, -82 and –AS).

We will no longer provide reimbursement for the temporary procedure codes S2066, S2067 or S2068 submitted on claims for breast reconstruction services rendered on and after November 15, 2021. Code 19364, the recognized code for reporting these breast reconstruction services, should be used when submitting claims for services rendered on and after November 15, 2021.

This policy applies to patients enrolled in Horizon:

  • Fully insured commercial plans,
  • Medicare Advantage plans
  • State Health Benefits Program/School Employees’ Health Benefits Program (SHBP/SEHBP) plans.

We encourage you to review the details of our Free Flap Breast Reconstruction reimbursement policy.

CPT® is a registered mark of the American Medical Association.

Published on: August 16, 2021, 00:08 a.m. ET
Last updated on: August 12, 2021, 00:50 a.m. ET