High impact
MA11.030j, Reconstructive Breast Surgery
Independence Blue Cross·Effective Dec 8, 2026
Independence Blue Cross Medicare Advantage is revising coverage for acellular dermal matrices (ADM) in reconstructive breast surgery effective 12/08/2026. Eight HCPCS codes are being removed from this policy and reclassified as experimental/investigational or moved to the Bioengineered Skin Substitutes policy (MA11.015). Additionally, Q4130 (Strattice) and Q4433 (361 hct/p skin substitute) are changing from medically necessary to experimental/investigational status. Billing teams must stop using these codes for reconstructive breast surgery claims and verify coverage under the new policy before claim submission.