Medicare AdvantageBilling CodesHigh impact
MA11.030i, Reconstructive Breast Surgery
Independence Blue Cross·Plastic Surgery, General Surgery, Oncology·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated CPT/HCPCS coding descriptors and terminology for reconstructive breast surgery materials effective 01/01/2026. Key changes include: Q4130 (Strattice) and Q4116 (AlloDerm) now specified as add-on codes with updated descriptors; Q4100 (generic skin substitute) terminated and replaced by Q4433; and C5271/C5272 (low-cost skin substitute application codes) removed from coverage. Billing teams must update systems to reflect new code terminology and add-on designations to avoid claim denials.
Action Required
By 12/31/2025: Billing team must update billing software and encoder systems to reflect HCPCS code changes effective 01/01/2026. Specific updates required: (1) Change Q4130 descriptor to 'Strattice tm, per square centimeter (add-on, list separately in addition to primary procedure)'; (2) Change Q4116 descriptor to 'Alloderm, per square centimeter (add-on, list separately in addition to primary procedure)'; (3) Terminate Q4100 and configure system to reject claims using this code; (4) Add Q4433 as active code with descriptor 'Skin substitute product, not otherwise specified (list in addition to primary procedure)'; (5) Terminate C5271 and C5272 in billing system to prevent incorrect billing. Update charge masters and encounter forms to flag Q4130, Q4116, and Q4433 as add-on codes requiring linkage to a primary procedure code. Train billing staff that claims submitted with terminated codes (Q4100, C5271, C5272) will be denied. Verify all reconstructive breast surgery templates in EMR reflect current covered procedures and required documentation per policy. Failure to implement these changes will result in claim denials and rework beginning 01/01/2026.