CCSD code B3014 – Breast reconstruction using an expandable implant

Key takeaways

CCSD code B3014 covers breast reconstruction using an expandable prosthesis, including delayed reconstruction, when no mastectomy takes place in the same operation.

A mastectomy with immediate expander reconstruction is billed as B3012, and a fixed prosthesis points to B3015 instead.

Bupa, AXA Health, Vitality, and Aviva expect prior authorization before admission, and retrospective requests are routinely declined.

The implant, anesthetic fee, and theater charges are billed separately and never folded into the surgeon’s B3014 fee.

The operation note has to show reconstructive intent and the expandable prosthesis used, because insurers match the note against the code.

CCSD code B3014 pays for expander-based breast reconstruction

CCSD code B3014 is the procedure code for reconstruction of breast using expandable prosthesis, including delayed reconstruction. The consultant surgeon bills it when a tissue expander or adjustable implant rebuilds the breast in an operation without the mastectomy.

The code comes from the schedule maintained by the Clinical Coding and Schedule Development (CCSD) group. UK private insurers, including Bupa, AXA Health, Vitality, Aviva, and WPA, use it to process surgical claims. B3014 sits in Chapter 7 (Breast), under Reconstruction, in the Major complexity band.

Several neighbors in the CCSD codes library read almost the same. So check the full descriptor before you pick one.

Quote the official descriptor word for word

Insurers match the code and its descriptor against the operation note, so quote the descriptor exactly instead of paraphrasing it.

CCSD also updates the schedule from time to time. Before you submit, confirm the current wording in the CCSD Technical Guide (updated October 2025).

B3014 covers the surgeon’s fee, and little else

B3014 pays the consultant surgeon for the reconstruction itself. The costs around it are billed separately. Knowing where that line falls prevents both underbilling and accidental overbilling.

Included within B3014:

• The consultant surgeon’s operative fee for the breast reconstruction
• Pre-operative assessment directly related to the surgery (where coded under the same episode)
• Intra-operative surgical work within the scope of the descriptor

Billed separately from B3014:

• Implant or prosthesis costs: billed separately using the appropriate CCSD implant or prosthesis code
• Anesthetic fee: the anesthetist submits their own CCSD claim
• Theater and facility charges: billed by the private hospital under its own fee schedule
• Post-operative follow-up beyond the standard post-procedure review: may need a separate consultation code

Misstating what B3014 includes is a common audit trigger. If an insurer’s fee schedule treats the code as a global surgical package, get that confirmed in writing before you submit. Surgeons used to NHS bundled tariffs are often caught out by this unbundled structure.

B3012, B3014 or B3015? The operation note decides

Choosing between neighboring breast codes is the most frequent cause of miscoding on these claims.

Two questions settle most cases. Was the mastectomy done in the same operation? And was the prosthesis expandable or fixed?

Two mistakes come up again and again. The first is billing B3015 when the operation note records an expander, or the reverse. The second is billing B3014 when the mastectomy happened in the same sitting, which belongs under B3012. Either error means the claim is rejected or paid at the wrong fee.

When the note is unclear, call the insurer’s provider helpline before you submit, not after a denial. Bupa’s code search tool, linked in the insurer table below, also shows whether a fee has been set for each code.

Prior authorization has to come before admission

Every major UK private insurer expects prior authorization for surgical breast reconstruction before the patient is admitted.

Retrospective authorization is almost never granted for elective surgery. As a result, a B3014 claim without a valid authorization reference is one of the fastest routes to rejection.

Surgeons moving from the NHS into private work often underestimate this step. In the NHS, clinical need drives admission. In private practice, the insurer’s authorization reference drives payment.

Record the authorization number in the patient record as soon as it arrives. That way it’s ready at submission, even when weeks pass between surgery and billing.

The operation note has to prove reconstruction

Insurers can request clinical records to validate any claim, and high-value reconstructive procedures draw more of those requests. A documentation routine set up before the operation saves hours of chasing afterward.

Before you submit, check that the patient file holds these five documents:

1. Referral letter: most insurers want evidence of a GP or specialist referral to confirm the procedure was clinically indicated.
2. Pre-authorization confirmation: the insurer-issued authorization number must appear on the claim form. Without it, the claim will not process.
3. Consent documentation: a signed consent form recording the procedure discussed, the risks explained, and the patient’s agreement.
4. Operation note: a contemporaneous note describing the procedure, laterality, and technique, including the expandable prosthesis used.
5. Implant batch or device record: most insurers require the implant batch number and manufacturer details for traceability.

Word the indication clearly, too. If the note reads like cosmetic surgery, Bupa and AXA Health may decline the claim as outside the policy.

Keeping all five documents in one patient record, linked to the claim, is the most reliable way to answer an evidence request quickly.

Submitting a B3014 claim takes six steps

Most UK private insurer claims go through Healthcode’s ePractice platform, which connects consultant practices to Bupa, AXA Health, Vitality, and other major payers. Claims prepared while the episode is still fresh tend to go out with fewer errors.

1. Confirm prior authorization is in place: retrieve the insurer-issued authorization number first. Never submit without it.
2. Select the correct CCSD code: use B3014 when the descriptor matches the procedure performed. Switch to B3012 if the mastectomy was in the same operation, or B3015 for a fixed prosthesis.
3. Attach supporting documents: file the referral letter, consent form, and operation note in the patient record, ready for any insurer request.
4. Complete all mandatory claim fields: membership or policy number, date of service, CCSD code, fee charged, authorization number, and consultant GMC number.
5. Submit via Healthcode ePractice or direct to the insurer: most insurers prefer electronic submission. Confirm the insurer’s preferred route in their provider portal first.
6. Record the submission date and reference: this creates an audit trail if the claim is queried or denied and you need to appeal.

Denied B3014 claims usually fail on paperwork

Denial patterns on breast reconstruction claims are consistent across insurers. Most trace back to authorization, code selection, or documentation, rather than disputes about clinical need.

Knowing the patterns in advance costs far less than chasing appeals:

• Missing or incorrect authorization number: the claim quotes a number that does not match insurer records, or none was obtained. The result is outright rejection, not a request for more information.
• Wrong CCSD code submitted: B3014 billed when B3012 or B3015 was correct. Insurers match the code against the operation note and reject any mismatch.
• Procedure described as cosmetic, not reconstructive: Bupa and AXA Health treat the two differently in their policies. Cosmetic-sounding language in the note can put the claim outside the patient’s cover.
• Implant costs included in the B3014 fee: bundling the prosthesis charge into the surgeon’s fee triggers an unbundling audit.
• Claim submitted outside the time limit: most insurers impose a 90-day or 6-month window from the procedure date. Late submissions are declined without review.
• Consultant not recognized by the insurer: the operating surgeon must be formally recognized as a provider. Claims from unrecognized consultants are rejected at submission.

If a claim is denied, ask for the insurer’s written reason code before you appeal. Appeals that don’t address the specific reason rarely succeed.

Surgeon, anesthetist, and hospital each bill their own share

Breast reconstruction is almost always a multi-party claim. The consultant surgeon bills B3014, while the anesthetist bills their own CCSD fee. The hospital then bills theater and recovery time. Each party submits a separate claim against the same authorization number.

Each party bills only its own element. The surgeon doesn’t bill the anesthetic fee, and the hospital doesn’t bill the operative fee. Insurers cross-check all three claims against the one authorization number and query any overlap, and duplicate billing can trigger a fraud investigation.

How Pabau keeps B3014 claims tied to the patient record

In many surgical practices, the authorization number lives in an email and the consent form in a scanned PDF. The claim itself sits in a separate billing portal. Each handoff is another chance to mistype a membership number or lose the reference.

Practice management software like Pabau keeps those pieces in one patient record. Its claims management software pre-fills the claim from that record. It also checks required fields, such as membership and authorization numbers, before you can send.

For UK insurers, claims go straight to Healthcode, so you can track their status without leaving the system. The payoff is fewer rejections for missing details and faster answers when an insurer asks for evidence.

Manage CCSD claims without the admin overhead

Pabau keeps consent forms, authorization numbers, and CCSD claims in one patient record. Your team can submit complete claims to Healthcode without chasing paperwork across systems.

Book a demo

Conclusion

B3014 is a narrow code. It pays for expander-based reconstruction on its own, so the first check is always whether the mastectomy happened in the same operation. Confirm that, make sure the operation note names the expander, and most coding queries never arise.

After that, the work is about sequence. Secure authorization before admission and keep the implant, anesthetic, and facility fees off the surgeon’s claim. Then submit well inside the insurer’s window.

If your team still assembles claims from emails and spreadsheets, a single patient record removes most of that risk. Book a demo to see how Pabau carries a reconstruction case from signed consent to a submitted Healthcode claim.

Continue your research

Coding a fixed implant instead? CCSD code B3015 covers reconstruction using a fixed prosthesis, the code most often confused with B3014.

Was the mastectomy in the same operation? CCSD code B3012 explains billing for mastectomy with immediate expander reconstruction.

Using a flap rather than an implant? CCSD code B2985 walks through free TRAM flap reconstruction and its Complex band.

Need a complete Bupa CCSD code reference? Bupa CCSD code schedule covers the codes Bupa recognizes, with guidance on submission.

Checking fees across Bupa codes? Bupa procedure fee schedule gives a structured reference for fees across Bupa-recognized CCSD codes.

Frequently asked questions