Medicare Benefits Schedule - Item 45527

Breast reconstruction (unilateral), following mastectomy, using a permanent prosthesis

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $784.05 Benefit: 75% = $588.05

(See para TN.8.96 of explanatory notes to this Category)

• Previous - Item 45524
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A Medicare benefit is generally not attracted under item 45524 unless the asymmetry in breast size is greater than 10%. Augmentation of a second breast sometime after an initial augmentation of one side would not attract benefits. Benefits are not payable for augmentation mammaplasty services performed using fat transfer to the breast. 

Item 45528 applies where bilateral mammaplasty is indicated because of malformation of breast tissue, disease or trauma of the breast, (but not as a result of previous cosmetic surgery) other than covered under item 45524 or 45527.

Volumetric measurement of the breasts should be performed using a technique which has been reported in a published study. 

Related Items: 45524 45527 45528