External silicone breast prosthesis worn in a bra without a built-in adhesive

This code describes an external breast prosthesis made of silicone or a comparable material, designed to be worn in a bra or attached to the body without an integrated adhesive. It is used to restore the appearance and balance of the chest wall following a mastectomy, lumpectomy, or other breast-altering surgery. This type of prosthesis aims to provide a natural contour and weight distribution for patients.

This code is appropriate for billing a non-adhesive, silicone-based external breast prosthesis provided to a patient who has undergone a mastectomy or significant breast tissue removal. Documentation should clearly indicate the medical necessity for a breast prosthesis, such as a diagnosis of absence of breast (e.g., Z90.1x) and a prescription from a physician. It is typically used for the initial provision or replacement of such a device.

• Ensure documentation specifies "without integral adhesive" to differentiate from adhesive-backed prostheses.
• Verify the material is silicone or an equivalent, as other materials may be coded differently.
• Do not use this code for custom-fabricated prostheses or those with integrated adhesive, which have separate codes.