FeeBase
Log inGet started
Menu

CPT code 19318: Breast reduction, tissue removal and reshaping2026 Medicare rate & RVUs

Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.7K Medicare services in 2024

Medicare pays $980.32 for 19318 nationally in a facility.

Medicare rate · 19318

Breast reduction, tissue removal and reshaping

Office or facility?

Work RVUs
15.63
Total RVUs
29.35
Global days
090

National rate · 2026

$980.32

Facility setting, before claim adjustments.

See every locality for 19318 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 19318 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 19318 covers

This operation reduces breast volume by removing tissue and skin and reshaping the remaining breast. It is commonly performed for symptomatic macromastia, such as breast-related neck, back, or shoulder discomfort, shoulder grooving, or recurrent skin irritation. A plastic surgeon or another surgeon with breast surgery expertise typically performs the procedure in a hospital or ambulatory surgery setting. The operative report should describe the tissue removal, reshaping, laterality, and clinical rationale.

Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies a 50% reduction to the others. An assistant at surgery 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 19318 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

19318 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$892.48
AlaskaUnavailable$1,220.31
ArizonaUnavailable$954.94
ArkansasUnavailable$881.69
Atlanta, GAUnavailable$1,007.51
Austin, TXUnavailable$990.93
Bakersfield, CAUnavailable$986.08
Baltimore area, MDUnavailable$1,038.34
Beaumont, TXUnavailable$940.95
Brazoria, TXUnavailable$959.51

19318 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
19318 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 19318 rate is calculated

Each of 19318’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 · 19318

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.63

15.63 RVUs× 1.000 GPCI

Practice expense10.76

10.76 RVUs× 1.000 GPCI

Malpractice2.96

2.96 RVUs× 1.000 GPCI

Adjusted RVUs

29.3500

Conversion factor

$33.4009

Medicare rate

$980.32

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 19318

19318 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19318

Breast reduction, tissue removal and reshaping

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 19318

Breast reduction, tissue removal and reshaping

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

19318 without 50 · national facility

$980.32

Breast reduction, tissue removal and reshaping

19318-50 · Bilateral: 150%

$1,470.48

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).

When to use modifier 50

19318 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 19318

    Breast reduction, tissue removal and reshaping15.63 wRVU

    Not priced

  • 19316

    Breast lift, ptosis correction10.81 wRVU

    Not priced

  • 19300

    Gynecomastia surgery, male breast tissue removal5.18 wRVU

    $637.29

  • 19325

    Breast augmentation, prosthetic implant placement7.92 wRVU

    Not priced

  • 19301

    Partial mastectomy, breast-conserving excision9.88 wRVU

    Not priced

How to choose

19316Breast liftPtosis correction
Use reduction mammoplasty when breast volume is reduced through tissue removal and reshaping. Mastopexy focuses on lifting and reshaping without the same volume-reduction objective.
19300Gynecomastia surgeryMale breast tissue removal
This code is for breast reduction, commonly for symptomatic macromastia. Code 19300 describes surgical treatment of gynecomastia.
19325Breast augmentationProsthetic implant placement
Reduction mammoplasty removes breast volume; code 19325 is used for breast augmentation with an implant.
19301Partial mastectomyBreast-conserving excision
Reduction mammoplasty addresses breast volume and contour. Code 19301 is used for partial removal of the breast, such as for a breast lesion.

Codes related to 19318

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 19318
CodeHow it relatesNational office range
Used instead
19316Breast lift, ptosis correctionBreast lift and reshaping when the procedure is not intended to reduce breast volume.No office rate
19300Gynecomastia surgery, male breast tissue removalUsed for surgical treatment of gynecomastia rather than reduction of the female breast.$557.92–$824.91
19325Breast augmentation, prosthetic implant placementIncreases breast volume with an implant rather than reducing it.No office rate

19318 billing questions

How is breast reduction different from mastopexy?

Reduction mammoplasty removes breast tissue and reduces volume while reshaping the breast. Mastopexy (19316) lifts and reshapes the breast without the same volume-reduction purpose.

How should bilateral breast reduction be reported?

Report modifier 50 for bilateral surgery. CMS pays the bilateral procedure at 150%.

Does the 90-day global period include routine postoperative care?

Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon be paid for this procedure?

CMS permits payment for an assistant at surgery. Co-surgeon payment requires supporting documentation.

How does CMS handle another procedure performed in the same session?

The highest-valued procedure is paid in full, and the other procedure or procedures are subject to the standard multiple procedure reduction.

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
RVUs for 19318PPRRVU2026_Oct_nonQPP.csv, line 1,693 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 19318 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 19318 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist