Special Billing & Insurance Considerations

  • Unfortunately, there seems to be a trend, regardless of type of reconstruction, there are often insurance coverage and billing issues.

  • Additionally, finding a doctor that will do a flat closure is still difficult. Communication is key to get the best outcome.

  • For your own sanity, go into this process knowing it is likely to be frustrating.

  • Setting your expectations correctly now will save you a lot of wasted energy.

Insurance.

As of 2025 no coding exists in the medical system for an aesthetic flat closure.

Code Description Example Workarounds

19303 Mastectomy, simple, complete (can be used when no reconstruction is done

19318 Reduction mammoplasty (sometimes used when contouring is part of closure)

19380Revision of reconstructed breast (used for flat closure revisions in some cases)

12034–12037 Layered closure of surgical wound (for complex closures, based on size)

15839Excision of redundant tissue (may apply during revision for aesthetic contouring)

17999Unlisted procedure, skin, mucous membrane and subcutaneous tissue (used when no existing code fully captures AFC; requires justification)

⚠️ Important: Surgeons often have to use modifier codes or detailed documentation when no code fully reflects AFC. Insurance may require pre-authorization or appeal for coverage.