ICD-10 Z45.81
Non-Billable HeaderEncounter for adjustment or removal of breast implant
About ICD-10-CM Z45.81
ICD-10-CM code Z45.81 represents Encounter for adjustment or removal of breast implant. This is a non-billable header code in the Factors Influencing Health Status chapter (block Z45). The 2026 edition of ICD-10-CM Z45.81 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under Z45.81. Per CMS ICD-10-CM Tabular 2026.
- Encounter for elective implant exchange (different material) (different size)
- Encounter for removal of tissue expander with or without synchronous insertion of permanent implant
Type 1 Excludes
Pure excludes, these codes can never be coded together with Z45.81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- complications of breast implant (T85.4-)
- encounter for initial breast implant insertion for cosmetic breast augmentation (Z41.1)
- encounter for breast reconstruction following mastectomy (Z42.1)
Medicare LCD Coverage for Z45.81
Local Coverage Determinations (LCDs) from CMS MACs that list Z45.81 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Z45.81.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Z45.81 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Z45.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To Z45.81
Other codes in section Z40-Z53 (Encounters for other specific health care).
ICD-10 Z45.81, Billing FAQ
Is ICD-10 code Z45.81 billable? +
No, Z45.81 is a non-billable header code. Use a more specific child code from block Z45 when submitting claims.
What other names or terms map to Z45.81? +
ICD-10 Z45.81 includes: Encounter for elective implant exchange (different material) (different size); Encounter for removal of tissue expander with or without synchronous insertion of permanent implant.
What codes are Type 1 Excludes for Z45.81? +
Type 1 Excludes (never code together with Z45.81): complications of breast implant (T85.4-); encounter for initial breast implant insertion for cosmetic breast augmentation (Z41.1); encounter for breast reconstruction following mastectomy (Z42.1)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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