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Ask a Rev Cycle Expert: Breast Implants – Code L8600 or C1789?

Question:

Our organization codes all Breast Implants with C1789 Prosthesis, Breast (Implantable). When would it be appropriate to bill/code HCPCS L8600 Implantable Breast Prosthesis, silicone or equal rather than C1789?

Answer:

Healthcare Common Procedure Coding System (HCPCS) code C1789 Prosthesis, Breast (Implantable) was established in 2001 to report breast prostheses that were eligible for pass-through payment under the OPPS. The code was inactivated once pass-through status expired but was reinstated in 2003 to allow hospitals to report charges associated with this supply on Medicare claims.

HCPCS code L8600 Implantable Breast Prosthesis, silicone or equal may be used to report the item for payers that do not use Medicare’s C-codes.

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