Medicare Benefits Schedule - Note TN.8.262

Item 45547 provides for the reinsertion of an existing prosthesis and not for insertion of a new prosthesis. Items 45553 and 45554 provide for the removal of a prosthesis and replacement with a new prosthesis.

Related Items: 45547 45553 45554

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Multiple Operation Rule

Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if:

(a) either:

(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or

(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.) (Assist.)

Fee: $629.15 Benefit: 75% = $471.90

(See para TN.8.98, TN.8.262 of explanatory notes to this Category)

Multiple Operation Rule

Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if:

(a) either:

(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or

(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and

(b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and

(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.) (Assist.)

Fee: $769.90 Benefit: 75% = $577.45

(See para TN.8.98, TN.8.262 of explanatory notes to this Category)

Multiple Operation Rule

Revision of breast prosthesis pocket, if:
(a) breast prosthesis or tissue expander has been placed for the purpose of breast reconstruction in the context of breast cancer or for developmental breast abnormality; and
(b) the prosthesis or tissue expander has migrated or rotated from its intended position or orientation; and
(c) the existing prosthesis is used
(H)

(Anaes.) (Assist.)

Fee: $769.90 Benefit: 75% = $577.45

(See para TN.8.262 of explanatory notes to this Category)