Clinical Coverage Policy Update: 1A-12 Breast Surgeries

Clinical Coverage Policy 1A-12 Breast Surgeries (which can be accessed at: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/physician-clinical-coverage-policies) has been updated to reflect changes throughout the policy.

Several additions have been added to male gynecomastia and breast reconstruction sections.  

Language for mastectomy coverage has been updated to “Mastectomy or Breast Conserving Surgery is covered when it is medically necessary.”

Breast Reconstruction, including tissue expanders and implant material had a limit of "once per occurrence of breast cancer” removed. No limit has been designated. 

All ICD-10 codes have been removed.

Refer to policy Section 5.1 for Prior Approval requirement.