YOUR RIGHTS
The Women’s Health and Cancer Rights Act of 1998 requires insurance companies to cover post mastectomy reconstruction, including areola/nipple tattooing. Insurance companies may reimburse some of the cost of the procedure but this is not guaranteed and it is up to the patient to submit the claim post procedure.
If looking for coverage it is advised that you contact your provider prior to your procedure to inform them you are in the process of preparing for Paramedical Micropigmentation to finalize your reconstruction post mastectomy due to breast cancer and inquire if Pre authorization is required and request a Predetermination of Procedure Benefit Allowance.
Insurance companies requirements may vary, therefore when speaking to them be sure to ask all pertinent information needed to facilitate your claim, however at minimum they usually require the following turned in:
– A prescription from your doctor with ICD-10 and CPT codes
– A claim reimbursement form which is found on their specific website
– A receipt of payment from the facility where the procedure was performed
– A letter of medical necessity provided by your doctor
– Your health history form filled out at your visit
– If prior authorization is required you will need the codes on your prescription
– Before/after photos are recommended to facilitate the process
Procedure and Diagnosis codes information necessary for pre-authorization and for claim reimbursement
PROCEDURE CODES
11921 (Unilateral) Tattooing and intradermal introduction of insoluble opaque pigments to correct color defects, including micropigmentation, 6.1 to 20.1 sq cm
11922 (Bilateral) Tattooing and intradermal introduction of insoluble opaque pigments to correct color defects, including micropigmentation, each additional 20.0 sq cm, or part thereof (list separately in addition to code for primary procedure)
DIAGNOSIS CODES
Z80.3 Family History of Malignant neoplasm of breast
Z85.3 Personal History of Malignant neoplasm of breast
Z90.11 Acquired absence of Right breast and Nipple
Z90.12 Acquired absence of Left breast and Nipple
Z90.13 Bilateral
N65.1 Breast Asymmetry on native breast or disproportion of reconstructed breast
N65.0 Deformity of reconstructed breast