MA11.030j, Reconstructive Breast Surgery
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.