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Treatment Algorithm Following Segmental Thermal Ablation

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Non-Covered Services

Non-Covered Services

www.harvardpilgrim.org

19105 Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma Provider liable — procedure code not eligible for payment 19396 Preparation of moulage for custom breast implant Member liable — not a covered service

  Ablation

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