How much does a double prophylactic mastectomy cost?

On MDsave, the cost of a Double Mastectomy ranges from $8,774 to $16,126. Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave.

Does United Healthcare cover prophylactic mastectomy?

UnitedHealthcare excludes Cosmetic Procedures from coverage including but not limited to the following: Breast reconstruction has been successfully completed post Mastectomy and the member chooses to enlarge their breasts for cosmetic reasons.

When is prophylactic mastectomy medically necessary?

Prophylactic mastectomy may be considered medically necessary when ONE or more of the following risk factors are present: Those with a strong family history of breast cancer such as: Having a mother, sister, and/or daughter who was diagnosed with bilateral breast cancer or with breast cancer before age 50 years; or.

What is the CPT code for mastectomy?

Report code 19303, Mastectomy, simple, complete, for the mastectomy.

How much does a mastectomy cost without insurance?

Out-of-Pocket Costs for Mastectomy

Without insurance, estimates for mastectomies range between $13,000 and $21,177.

How is a prophylactic mastectomy performed?

Bilateral prophylactic mastectomy may involve complete removal of both breasts, including the nipples (total mastectomy), or it may involve removal of as much breast tissue as possible while leaving the nipples intact (subcutaneous or nipple-sparing mastectomy).

What age is prophylactic mastectomy?

A recent survival analysis suggested that prophylactic mastectomy at age 25 years and oophorectomy at age 40 years maximized survival at 70 years of age; however, substituting enhanced breast cancer screening (with MRI and mammogram) for mastectomy resulted in similar survival.

How painful is a prophylactic mastectomy?

93% of patients answered the questionnaire. 69% reported pain and 71% discomfort in the breasts. Lost or much reduced sexual sensations were reported by 85% and enjoyment of sex was negatively impacted for 75% of patients.

How effective is prophylactic mastectomy?

How effective are these surgeries? Bilateral prophylactic mastectomy can reduce the risk of breast cancer by at least 95 percent if you have a disease-causing mutation in your BRCA1 or BRCA2 gene, according to the National Cancer Institute.

Can I opt for a double mastectomy?

Some women who've been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed -- a double mastectomy. Removing the other healthy breast is called contralateral prophylactic mastectomy.

How do you bill bilateral mastectomy?

Report a “1” in the number-of-services field. For example, if you are billing for a bilateral mastectomy, you would report CPT code 19303 (Mastectomy, simple, complete) with the modifier. You would report the service as a single line item: 19303 50.

What is the difference between a simple mastectomy and a modified radical mastectomy?

A simple mastectomy (left) removes the breast tissue, nipple, areola and skin but not all the lymph nodes. A modified radical mastectomy (right) removes the entire breast — including the breast tissue, skin, areola and nipple — and most of the underarm (axillary) lymph nodes.

What is a subcutaneous mastectomy?

Subcutaneous mastectomy involves removal of most of the breast tissue with preservation of the nipple-areola complex. Subcutaneous mastectomy can be performed as an open procedure through an incision in the inframammary crease or via a minimally invasive or endoscopic approach.

Can you have an elective mastectomy?

When cancer invades one breast, many women opt to remove both. Two new studies highlight the trend toward elective double mastectomy. An increasing number of women diagnosed with cancer in one breast are choosing to have both breasts removed.

How long is recovery from prophylactic mastectomy?

Average recovery time after mastectomy and reconstruction is about 3-4 weeks, but may be up to 6-8 weeks. During that time, there may be restrictions against driving and activities that involve lifting or raising the arms up over the head.

Do you keep your nipples after a mastectomy?

When treating breast cancer with a mastectomy, the nipple is typically removed along with the rest of the breast. (Some women might be able to have a nipple-sparing mastectomy, where the nipple is left in place.

Does CPT 11970 include capsulotomy?

The exchange of the tissue expander for a permanent implant requires a capsulotomy so the only code for that procedure is 11970 (not 19340, 19370, 19380). The fat grafting may be separately reported using 20926 which includes the harvest and placement/injection of the fat into the defect.

What does CPT code 19302 mean?

CPT code 19302 is only reported when “all identifiable axillary lymph nodes are removed” — A separate incision may be made but that is not what determines coding, reporting is based on the extent of axillary lymph node dissection. The information provided should be utilized for educational purposes only.

What is procedure code 19303?

The correct code to report skin-sparing mastectomy is 19303, Mastectomy, simple, complete (total mastectomy).

How much is a single mastectomy?

When it comes to costs, the researchers calculated that a double mastectomy translates to an average cost of $18,577 over 20 years, while a single mastectomy – including 20 years of routine screening – costs an average of $13,525. This puts a single mastectomy's costs at over $5,000 less.