Gynecomastia ICD-10 Code: N62 and What It Means

The ICD-10 code for gynecomastia is N62, “hypertrophy of breast.” That one code covers male and female breast enlargement, so it says nothing about how large the tissue is, how long you have had it, or whether surgery is appropriate. I am Dr. Babak Moeinolmolki, and I get this question most often from men who are looking at an insurance form or a patient portal and want to know what the code means.

What Is the ICD-10 Code for Gynecomastia?

Gynecomastia is generally coded with ICD-10-CM code N62, which is titled “hypertrophy of breast.” The code is billable, and it is the same code used for breast enlargement in women. The CDC’s National Center for Health Statistics publishes the official ICD-10-CM code set each year (CDC ICD-10-CM page).

ICD-10 codes describe a diagnosis. They are not a grade, a measurement, or a treatment plan. When you see N62 on a visit summary, it tells an insurer that a clinician documented breast tissue enlargement. The exam note is what explains the rest.

Gynecomastia Codes at a Glance

Which codes appear on your claim varies by case. Your surgeon’s billing team chooses them from the chart, and they should match what was done in the operating room.

Does the Diagnosis Code Decide Insurance Coverage?

No. A diagnosis code only opens the door to a review. Whether gynecomastia surgery is covered depends on the plan’s written policy, and many policies classify it as cosmetic. Aetna’s published clinical policy, for example, lists breast reduction, mastectomy, or liposuction for gynecomastia as cosmetic and says any reversible cause, such as a medication, should be addressed with medical treatment first (Aetna Clinical Policy Bulletin).

That is one insurer’s policy, and other plans write theirs differently. Some will review a request when the chart documents persistent pain or tenderness, a completed workup, and no improvement after the cause was treated. Others decline outright. I walk through how requests are usually documented in how to get gynecomastia surgery covered by insurance, and the plan-by-plan realities are in gynecomastia surgery insurance coverage.

What Does the Chart Need to Show Besides N62?

The chart needs to show a documented exam, how long the tissue has been present, what was ruled out, and what was tried. The code is one line. The supporting note is what a reviewer reads.

When I document a patient, I record the following so the request does not rest on a code alone:

• Whether the tissue is firm gland, soft fat, or a mix, as found on hands-on exam. Gynecomastia versus pseudogynecomastia matters here because fat alone is treated differently from gland.
• How long it has been present and whether it is tender, painful, or changing.
• The workup that was done, such as medication review, hormone labs, or imaging, covered in how gynecomastia is diagnosed.
• Any medication or condition that may be driving it. The list is in medications that cause gynecomastia.

Mayo Clinic describes the common causes and when to see a doctor, which is a good reference if you are still sorting out why the tissue appeared (Mayo Clinic: gynecomastia).

Is the Gynecomastia ICD-10 Code the Same as a Severity Grade?

No. N62 does not carry a grade. Severity is a surgical description, and it lives in the exam note. Surgeons commonly describe gynecomastia with grading systems that run from mild, button-sized tissue to large tissue with excess skin. Those grades help plan the operation, but they are separate from the diagnosis code.

If you want to see how I describe severity in practice, my pages on gynecomastia surgery cover the approach, and the pages on grade 3 gynecomastia and grade 4 gynecomastia explain what the more advanced levels look like.

What CPT Code Is Used for Gynecomastia Surgery?

CPT 19300, mastectomy for gynecomastia, is the procedure code most often associated with surgical removal of gland tissue. Some operations combine gland excision with liposuction, and the codes billed depend on exactly what was performed. Your surgeon’s office confirms the codes before any prior authorization request goes out.

Aetna’s policy lists 19300 among the procedures it does not cover for gynecomastia, which shows why checking your own plan matters before you plan around coverage.

What Should You Do If You Need the Code for a Form?

Ask the clinician who examined you. Do not pick a code from the internet to fill in a form, because the code has to match what was documented at your visit. If you have a visit summary, the diagnosis code is usually printed near the bottom, and your doctor’s office can tell you which codes were submitted.

If you are weighing surgery and want to know where your plan stands, bring your insurance card to a consultation and ask the office to explain the plan’s gynecomastia policy in writing. Costs and coverage vary by case, and a straight answer up front saves a lot of back-and-forth later.

Why Do Men Ask About the Code at All?

Most men see the code in one of three places: a patient portal after a primary care visit, an explanation of benefits from an insurer, or a pre-authorization form before surgery. The code can look alarming out of context, especially because the title says “hypertrophy of breast.” It is a billing label for enlarged breast tissue, and it does not mean something dangerous was found.

If the word cancer crosses your mind when you see it, the code does not say anything about that. A new hard, one-sided lump, skin dimpling, or nipple discharge needs a clinical exam and often imaging, regardless of what is printed on a form. Do not wait on paperwork to get that looked at.

How Does Prior Authorization Work for Gynecomastia Surgery?

Prior authorization is the insurer’s review before surgery. Your surgeon’s office submits the diagnosis code, the planned procedure code, the exam notes, and any supporting records. The insurer compares them to its written policy and replies with an approval, a denial, or a request for more information. The process takes time, and a denial is common when the plan classifies the operation as cosmetic.

If you are denied, you can ask for the reason in writing and for the policy the decision was based on. That document tells you whether anything in your chart could change the outcome. Many men choose to move forward as self-pay instead, and I give ranges for that rather than a fixed number, because the cost varies by case.

Next Step

If you have male breast tissue and want a clear exam, a diagnosis, and an honest talk about options, book a consultation. I will tell you what I find, whether surgery makes sense, and what to expect from your plan. There is no pressure to decide at the visit.

FAQ

What is the ICD-10 code for gynecomastia?

The ICD-10-CM code usually used for gynecomastia is N62, titled hypertrophy of breast. The code does not distinguish men from women, so the chart notes, exam findings, and any imaging carry the detail that shows the diagnosis is gynecomastia.

Is gynecomastia surgery covered by insurance?

Coverage depends on the individual plan. Many plans treat gynecomastia surgery as cosmetic, and some review it case by case when there is documented pain, a workup, and a failed trial of other treatment. A diagnosis code alone does not guarantee approval.

What CPT code is used for gynecomastia surgery?

CPT 19300, mastectomy for gynecomastia, is the procedure code most often used. Liposuction-based approaches may be coded differently, and the surgeon’s office confirms the correct codes for your operation before a prior authorization request.

Does the ICD-10 code show whether gynecomastia is mild or severe?

No. N62 has no grade or severity built in. Severity is documented in the exam note, and surgeons often describe it with a grading system such as Simon grades 1 through 3, which is separate from the billing code.

Can the code change if my gynecomastia is caused by a medication?

Yes. A coder may add a second code for the drug or condition behind the tissue growth. Your doctor decides what is documented, and the chart should explain the cause when it is known.

* Illustrative images on this page are models, not actual patients. Real patient results are shown in our Before & After gallery.