S28.222A: Partial traumatic amputation of left breast, initial encounter
S28.222A, partial traumatic amputation of left breast, initial encounter, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 36 HCPCS Level II codes, including G0279 (Diagnostic digital breast tomosynthesis, unilateral or…), C8903 (Magnetic resonance imaging with contrast, breast; unilateral), C8905 (Magnetic resonance imaging without contrast followed by…). The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with S28.222A as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | Carrier judgment | — | 1 |
| C8903 | Magnetic resonance imaging with contrast, breast; unilateral | Special coverage instructions apply | — | 1 |
| C8905 | Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral | Special coverage instructions apply | — | 1 |
| C8906 | Magnetic resonance imaging with contrast, breast; bilateral | Special coverage instructions apply | — | 1 |
| C8908 | Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral | Special coverage instructions apply | — | 1 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | Special coverage instructions apply | — | 2 |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 1 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 1 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 1 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 1 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 1 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | Special coverage instructions apply | — | 1 |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram | Carrier judgment | — | 1 |
| J0850 | Injection, cytomegalovirus immune globulin intravenous (human), per vial | Special coverage instructions apply | — | 1 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 1 |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | Special coverage instructions apply | — | 1 |
| J1571 | Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml | Special coverage instructions apply | — | 1 |
| J1573 | Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml | Carrier judgment | — | 1 |
| J1577 | Injection, immune globulin (qivigy), 100 mg | Carrier judgment | — | 1 |
11 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing S28.222A
- A56448: Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33950
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L34771
- A55909: Billing and Coding: Wound Care (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L35125, L37166, L37228
- A52438: Billing and Coding: Tetanus Immunization (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes)
- A54767: Billing and Coding: Medicare Preventive Coverage for Certain Vaccines (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes)
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other S28 diagnoses (Crushing injury of thorax, and traumatic amputation of part of thorax)
- S28.221A — Partial traumatic amputation of right breast, initial encounter
- S28.211A — Complete traumatic amputation of right breast, initial encounter
- S28.212A — Complete traumatic amputation of left breast, initial encounter
- S28.1XXA — Traumatic amputation (partial) of part of thorax, except breast…
Frequently asked questions
Does Medicare cover S28.222A (Partial traumatic amputation of left breast, initial…)?
Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list S28.222A as a covered diagnosis for 36 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 S28.222A?
The Level II codes from the policies most specific to this diagnosis are G0279 (Diagnostic digital breast tomosynthesis, unilateral or…, 1 article); C8903 (Magnetic resonance imaging with contrast, breast; unilateral, 1 article); C8905 (Magnetic resonance imaging without contrast followed by…, 1 article); C8906 (Magnetic resonance imaging with contrast, breast; bilateral, 1 article); C8908 (Magnetic resonance imaging without contrast followed by…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list S28.222A?
A56448 (Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography); A57554 (Billing and Coding: Immune Globulins); A55909 (Billing and Coding: Wound Care), and 2 more articles.
What is ICD-10-CM code S28.222A?
S28.222A is the ICD-10-CM code for partial traumatic amputation of left breast, initial encounter, in category S28 (Crushing injury of thorax, and traumatic amputation of part of thorax), chapter 19: Injury, poisoning and other consequences of external causes.
Next steps
- Run a reimbursement report for a device billed under G0279
- Watch G0279 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0279
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup