N64.81

N64.81: Ptosis of breast

Billable / specific codeICD-10-CM

N64.81 is a billable, specific ICD-10-CM code for ptosis of breast. It is valid for submission on a claim.

Check N64.81 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

ptosis of native breast in relation to reconstructed breast (N65.1)

Excludes2 inherited from the categories above N64.81

Not part of this code, but both may be coded when both are present.

Written on N64: Other disorders of breast

mechanical complication of breast prosthesis and implant (T85.4-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

N64.81 is named in 4 Medicare coverage policies: 4 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56587Billing and Coding: Cosmetic and Reconstructive Surgery
A58573Billing and Coding: Cosmetic and Reconstructive Surgery
A58774Billing and Coding: Cosmetic and Reconstructive Surgery
A59299Billing and Coding: Cosmetic and Reconstructive Surgery

Alphabetic index entries that lead here

Ptosis›breast

Code history

Unchanged in every release from FY2024 to FY2027.