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Thread: Bilateral Breast Augmentation

  1. #1

    Default Bilateral Breast Augmentation

    AAPC: Back to School
    My plastic surgeon is having issues concerning cosmetic breast augmentation. He is doing bilateral breast augmentationa and we know to add the modifier 50 to the code, but he feels that the fee for the augmentation, since it is cosmetic is too high for self paying patients. Do you all charge a separate fee depending if the patient only has one breast done compared to two? Thanks

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Multiple surgery discount

    Most insurers will deeply discount the second procedure performed in a single operative session. This is because the payment for every surgical procedure include pre- and post-operative management.

    Typical discount for the second procedure is 50%.

    So, for example. Let's say the insurer pays $1,000 for augmentation on one breast (making the math simple). If you are augmenting both breasts in the same operative session, they will discount the second breast augmentation by 50% ... i.e. they will pay only $500 for the second procedure, for a total payment of $1,500 (not $2,000).

    You can do the same thing in setting up your cosmetic self-pay fees. If the fee for one breast is $2,000 you can state that the fee for bilateral procedure (done at the same operative session) is $3,000.

    A healthcare attorney is the best source for competent answers about what it is legal to do or not do.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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