CPT code 19318: Breast reduction, tissue removal and reshaping2026 Medicare rate & RVUs in Maryland
Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume.
CMS doesn’t publish an office rate for 19318 in Maryland.
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 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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $1,038.34 |
| Rest of Maryland | Unavailable | $981.74 |
| Washington, DC area | Unavailable | $1,083.65 |
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
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
| 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 · 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.
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).
19318 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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