Common codes
| Code | Used for | Base units |
|---|---|---|
| 00400 | Skin and soft tissue procedures on the extremities, front of the trunk and perineum | 3 |
| 00402 | Breast reconstruction | 5 |
Base units shown are the standard values most payers use. Check your payer and the current year's CMS base unit file before relying on them.
Radical procedures, like a mastectomy with lymph node removal, have their own codes and higher units.
Cosmetic or covered?
Reconstruction after a mastectomy is covered by most plans. Cosmetic breast surgery usually isn't. For cosmetic cases, agree on a self-pay price and collect it before the day. See office-based anesthesia billing for how self-pay works.
Blocks
Pectoral or paravertebral blocks for pain after surgery may be billed separately if the surgeon asked for them and they weren't the main anesthetic. See nerve block billing.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.
Sources
- CMS: Medicare Claims Processing Manual, Chapter 12 (Anesthesia)
- Maryland Workers' Compensation Commission: anesthesia base unit values