CPT code 19316: Breast lift, ptosis correction2026 Medicare rate & RVUs in California
Reports an operation that elevates and reshapes a ptotic breast, generally by removing excess skin and repositioning breast tissue and the nipple-areola complex.
CMS doesn’t publish an office rate for 19316 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 19316 covers
This operation lifts and reshapes a breast by removing excess skin and repositioning breast tissue and the nipple-areola complex higher on the chest. Plastic surgeons commonly perform it for breast drooping after pregnancy, weight change, or aging, usually in an ambulatory surgery center or hospital operating room. The main goal is improved position and contour, rather than substantial removal of breast volume. A lift may be combined with implant augmentation when the patient also seeks increased volume.
Report the procedure for each treated breast and document the indication, laterality, operative work, and any accompanying procedure. For bilateral surgery, CMS pays reporting with modifier 50 at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 19316 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $736.69 |
| Chico, CA | Unavailable | $730.77 |
| El Centro, CA | Unavailable | $731.13 |
| Fresno, CA | Unavailable | $730.77 |
| Hanford, CA | Unavailable | $730.77 |
| Los Angeles, CA | Unavailable | $774.38 |
| Madera, CA | Unavailable | $730.77 |
| Marin County, CA | Unavailable | $846.70 |
| Merced, CA | Unavailable | $730.77 |
| Modesto, CA | Unavailable | $730.77 |
| Napa, CA | Unavailable | $811.31 |
| Oxnard, CA | Unavailable | $766.47 |
| Redding, CA | Unavailable | $730.77 |
| Rest of California | Unavailable | $730.77 |
| Riverside, CA | Unavailable | $753.69 |
| Sacramento, CA | Unavailable | $757.53 |
| Salinas, CA | Unavailable | $754.54 |
| San Benito County, CA | Unavailable | $867.09 |
| San Diego, CA | Unavailable | $765.59 |
| San Francisco, CA | Unavailable | $844.28 |
| San Luis Obispo, CA | Unavailable | $743.54 |
| Santa Clara County, CA | Unavailable | $857.20 |
| Santa Cruz, CA | Unavailable | $767.55 |
| Santa Maria, CA | Unavailable | $755.53 |
| Santa Rosa, CA | Unavailable | $774.66 |
| Stockton, CA | Unavailable | $730.77 |
| Vallejo, CA | Unavailable | $807.82 |
| Visalia, CA | Unavailable | $730.77 |
| Yuba City, CA | Unavailable | $730.77 |
How the 19316 rate is calculated
Each of 19316’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 19316
RVUs × geographic indexes × conversion factor
Work10.81
10.81 RVUs× 1.000 GPCI
Practice expense8.89
8.89 RVUs× 1.000 GPCI
Malpractice2.13
2.13 RVUs× 1.000 GPCI
Adjusted RVUs
21.8300
Conversion factor
$33.4009
Medicare rate
$729.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19316
19316 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19316
Breast lift, ptosis correction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19316
Breast lift, ptosis correction
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19316 without 50 · national facility
$729.14
Breast lift, ptosis correction
19316-50 · Bilateral: 150%
$1,093.71
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
19316 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19318Breast reductionTissue removal and reshaping
- Choose 19316 for lifting and reshaping when improved position is the main goal. Choose 19318 when reducing breast volume is the primary work.
- 19325Breast augmentationProsthetic implant placement
- 19325 reports implant augmentation to increase breast volume. It may accompany 19316 when the same operation also lifts and reshapes the breast.
- 19380Breast revisionReconstructed breast
- 19380 is for revision of a reconstructed breast. This code addresses lifting and reshaping a ptotic breast, not revision of a reconstruction.
19316 billing questions
How is this procedure distinguished from breast reduction?
Use this code when the principal work is lifting and reshaping a drooping breast. Code 19318 describes reduction when breast-volume removal is the primary objective.
Can this be reported with breast augmentation?
Yes, a lift and implant augmentation may be performed in the same session when both contour and volume are being addressed. CMS applies its multiple procedure reduction when procedures are performed together.
How should bilateral surgery be reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care. Document separately identifiable services when they are outside that included care.
May an assistant or co-surgeon be paid?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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