Medicare Benefits Schedule - Note TN.8.167

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.167

Breast Prosthesis Removal (Item 45551)

Providers should note that 45551 is intended to be claimed when there is a medical indication for performing capsulectomy, such as capsular contracture, presence of a mass within the capsule (seen on pre-operative imaging or intraoperatively) or evidence of Breast Implant Associated Anaplastic Large Cell Lymphoma or other malignancy. If this item is claimed the capsule must be sent for histopathology.

Related Items: 45551


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Category 3 - THERAPEUTIC PROCEDURES

45551

45551 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2021

Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report

(Anaes.) (Assist.)

Fee: $461.65 Benefit: 75% = $346.25

(See para TN.8.167 of explanatory notes to this Category)


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change