Z42.1
Z42.1: Encounter for breast reconstruction following mastectomy
Billable / specific codeICD-10-CMPOA exempt
Z42.1 is a billable, specific ICD-10-CM code for encounter for breast reconstruction following mastectomy. It is valid for submission on a claim.
Check Z42.1 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- deformity and disproportion of reconstructed breast (N65.1-)
Excludes1 inherited from the categories above Z42.1
A category’s note binds every code beneath it.
Other codes that can never be billed with Z42.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
Z42.1 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56587Billing and Coding: Cosmetic and Reconstructive Surgery
- A56658Billing and Coding: Cosmetic and Reconstructive Surgery
- A57221Billing and Coding: Plastic Surgery
- A58573Billing and Coding: Cosmetic and Reconstructive Surgery
Alphabetic index entries that lead here
- Admission›breast reconstruction following mastectomy
- Encounter›breast reconstruction following mastectomy
Code history
Unchanged in every release from FY2024 to FY2027.