Breast removal/replace implant

Arlene

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I have a situation that dr. did a remove/replace implants on a patient as cosmetic procedure ( implants harden) Now over a month later- wound opened with infection. Previously no signs of problems and pt was getting along fine.
Can dr remove the implant under insurance? Pt has medicare & 2nd coverage. He will be doing this in the office.
 

mzemla309

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Since the patient has Medicare, you should review your Local Coverage Determination (LCD). Our carrier is WPS and they will cover removal of the implant with diagnosis 996.54 for example. Please note that while the removal of the implant may be covered regardless of whether the implant was placed for reconstructive or cosmetic purposes. They probably won't cover placing a new implant if it is being performed for cosmetic purposes.
 
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