Transcription of External Breast Protheses - Health Plan
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External Breast Protheses - Health Plan
External Breast prostheses 1 External Breast prostheses Adopted from the National Government Services website. For any item to be covered by The Health Plan, it must: 1. Be eligible for a defined Medicare or The Health Plan benefit category 2. Be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member 3. Meet all other applicable Medicare and/or The Health Plan statutory and regulatory requirements For the items addressed in this medical policy, the criteria for "reasonable and necessary" are defined by the following indications and limitations of coverage and/or medical necessity.
EXTERNAL BREAST PROSTHESES 4 HCPCS CODES A4280 Adhesive skin support attachment for use w/external breast prosthesis, each L8000 Breast prosthesis, mastectomy bra L8001 Breast prosthesis, mastectomy bra, w/integrated breast prosthesis form, unilateral L8002 Breast prosthesis, mastectomy bra, w/integrated breast prosthesis form, bilateral
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