Z90.12
Z90.12 — Acquired absence of left breast and nipple
Billable / specific codeICD-10-CMPOA exemptleft
Z90.12 is a billable, specific ICD-10-CM code for acquired absence of left breast and nipple. It is valid for submission on a claim.
Risk adjustment
Z90.12 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
Z90.12 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52478External Breast Prostheses - Policy Article
- A56658Billing and Coding: Cosmetic and Reconstructive Surgery
- A58774Billing and Coding: Cosmetic and Reconstructive Surgery
- A59299Billing and Coding: Cosmetic and Reconstructive Surgery
Related codes at this level
Codes that share Z90.1. If Z90.12 is not quite right, the correct code is usually one of these.
Questions about Z90.12
- Is Z90.12 a billable ICD-10-CM code?
- Yes. Z90.12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Z90.12 sit in the tabular list?
- Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).