Summary & Overview
HCPCS C1789: Implantable Breast Prosthesis
HCPCS Level II code C1789 represents an implantable breast prosthesis used in reconstructive or cosmetic breast procedures. As an HCPCS Level II device code, C1789 is used on facility and supplier claims to identify the prosthetic device itself rather than the surgical procedure. Nationally, accurate coding of implantable prostheses affects device tracking, billing clarity between device and surgical services, and payer coverage determinations for reconstruction following mastectomy or augmentation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is applied in clinical billing, typical sites of service where the device is implanted, and the payer landscape that commonly adjudicates claims for breast prostheses. The publication summarizes common modifier use and coding considerations, outlines typical documentation elements needed to support device billing, and highlights where data is not available in the input.
This summary is written for a national audience and provides practical context for coding teams, revenue cycle leaders, and clinicians involved in breast reconstruction and implantable device supply chain management. Data not available in the input is identified where relevant.
Billing Code Overview
HCPCS Level II code C1789 denotes prosthesis, breast (implantable). This code covers implantable breast prosthetic devices used in reconstructive or cosmetic breast procedures.
Service type: Implantable medical device placement.
Typical site of service: Hospital operating room, ambulatory surgical center, or outpatient surgical facility.
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman undergoing breast reconstruction or revision who requires an implantable breast prosthesis (C1789). Common scenarios include immediate reconstruction following mastectomy for breast cancer, delayed reconstruction after cancer treatment, or revision of a prior augmentation/reconstruction for implant rupture, capsular contracture, asymmetry, or size change. The clinical workflow begins with preoperative evaluation by a plastic surgeon, including history, oncologic status review, imaging as appropriate (mammography/ultrasound/MRI), and discussion of implant type and size. Preauthorization and documentation of medical necessity for C1789 are obtained when required. On the day of surgery, the implant is placed in a sterile operating room environment under general anesthesia or monitored anesthesia care, often accompanied by adjunctive procedures (e.g., capsulectomy, tissue expander exchange, acellular dermal matrix placement, fat grafting). Postoperative care includes wound checks, pain control, and follow-up for detection of complications such as infection, hematoma, implant rupture, or contracture. Billing uses C1789 for the implantable breast prosthesis supply; operative CPT codes and appropriate modifiers are appended per payer and clinical circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|