Is breast reconstruction a covered Medicare procedure?
A. Yes. CMS Pub 100-03 Section 140.2 of the National Coverage Determinations Manual states that breast reconstruction of the affected and the contralateral unaffected breast following a medically necessary mastectomy is a covered procedure. Medicare will not cover breast reconstruction for cosmetic reasons. Q. In the Outpatient Pulmonary Rehabilitation Services policy, HCPCS 97750, used for the 6-minute walk is under revenue codes 42X and 43X only. In most programs, PT and OT are not involved in pulmonary rehabilitation, so how can the nurses or RT bill for the 6-minute walk? A. The 6-minute walk should be coded with 97XXX codes, which require that a PT or OT perform them. If a facility chooses not to employ PTs and OTs in their Pulmonary Rehabilitation program, they may not bill these services. Other disciplines maybe capable of performing the functions described by these codes, but may not use these codes in billing. Q. For the physical therapist to perform an unnecessary evaluation
