CPT code 19350: Nipple reconstruction, nipple–areola reconstruction2026 Medicare rate & RVUs in Santa Rosa, CA
Reports surgical reconstruction of the nipple and areola, commonly as a later stage of breast reconstruction after mastectomy.
In Santa Rosa, CA, Medicare pays $1,000.27 for 19350 in the office and $659.01 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 19350 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 19350 covers
This service recreates the nipple and areola, most often after mastectomy and reconstruction of the breast mound. A plastic surgeon or other surgeon experienced in breast reconstruction may use local tissue rearrangement to create nipple projection and grafting or other reconstructive techniques for the areola. It is commonly performed in an outpatient or hospital setting as a later stage of reconstruction.
Report 19350 for the nipple-and-areola reconstruction itself, not for correction of an inverted nipple or a broader revision of the reconstructed breast. The operative note should describe the reconstructed anatomy and work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are 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.
How Santa Rosa, CA compares for 19350
Across 109 of 109 payment localities, the office rate for 19350 runs from $790.41 in Arkansas to $1,139.86 in San Benito County, CA. Santa Rosa, CA pays $1,000.27. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Santa Rosa, CA · this page$1,000.27
- Bakersfield, CA · California$929.61−$70.66
- Chico, CA · California$924.95−$75.32
- El Centro, CA · California$925.22−$75.05
- Fresno, CA · California$924.95−$75.32
- Hanford, CA · California$924.95−$75.32
- Los Angeles, CA · California$986.31−$13.96
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $924.95 | $620.37 |
| Merced, CACalifornia | $924.95 | $620.37 |
| Modesto, CACalifornia | $924.95 | $620.37 |
| Napa, CACalifornia | $1,057.22 | $690.96 |
| Oxnard, CACalifornia | $979.62 | $651.15 |
| Redding, CACalifornia | $924.95 | $620.37 |
| Rest of CaliforniaCalifornia | $924.95 | $620.37 |
| Riverside, CACalifornia | $942.92 | $638.35 |
| Sacramento, CACalifornia | $966.86 | $643.66 |
| Salinas, CACalifornia | $963.21 | $641.13 |
| San Diego, CACalifornia | $983.28 | $650.92 |
| Marin County, CACalifornia | $1,113.79 | $721.96 |
| San Francisco, CACalifornia | $1,111.90 | $720.06 |
| San Benito County, CACalifornia | $1,139.86 | $739.14 |
| Santa Clara County, CACalifornia | $1,132.11 | $731.39 |
| San Luis Obispo, CACalifornia | $948.23 | $631.70 |
| Santa Cruz, CACalifornia | $990.56 | $652.92 |
| Santa Maria, CACalifornia | $966.11 | $642.08 |
| Stockton, CACalifornia | $924.95 | $620.37 |
| Vallejo, CACalifornia | $1,054.49 | $688.23 |
| Visalia, CACalifornia | $924.95 | $620.37 |
| Yuba City, CACalifornia | $924.95 | $620.37 |
| Washington, DC areaDistrict of Columbia | $1,012.50 | $685.14 |
| Miami, FLFlorida | $1,001.29 | $712.00 |
| Chicago, ILIllinois | $970.83 | $691.54 |
| Manhattan, NYNew York | $1,033.19 | $710.27 |
| AlaskaAlaska | $1,052.26 | $756.30 |
| AlabamaAlabama | $801.92 | $558.76 |
| ArkansasArkansas | $790.41 | $551.70 |
| ArizonaArizona | $868.99 | $599.71 |
| ColoradoColorado | $919.80 | $624.12 |
| ConnecticutConnecticut | $953.14 | $653.85 |
| DelawareDelaware | $883.16 | $608.60 |
| Fort Lauderdale, FLFlorida | $945.92 | $664.41 |
| Rest of FloridaFlorida | $898.04 | $632.37 |
| Atlanta, GAGeorgia | $914.57 | $632.23 |
| Rest of GeorgiaGeorgia | $846.04 | $598.16 |
| Hawaii, Guam, HIHawaii | $944.50 | $628.53 |
| IowaIowa | $814.15 | $559.88 |
| IdahoIdaho | $821.10 | $565.43 |
| East St. Louis, ILIllinois | $907.05 | $651.39 |
| Rest of IllinoisIllinois | $878.11 | $624.39 |
| Suburban Chicago, ILIllinois | $953.56 | $668.17 |
| IndianaIndiana | $825.61 | $568.00 |
| KansasKansas | $814.16 | $562.95 |
| KentuckyKentucky | $828.97 | $581.92 |
| New Orleans, LALouisiana | $869.45 | $607.95 |
| Rest of LouisianaLouisiana | $829.20 | $583.26 |
| Metropolitan Boston, MAMassachusetts | $1,004.87 | $673.06 |
| Rest of MassachusettsMassachusetts | $915.93 | $623.30 |
| Baltimore area, MDMaryland | $951.30 | $653.12 |
| Rest of MarylandMaryland | $898.70 | $617.47 |
| Rest of MaineMaine | $829.41 | $573.75 |
| Southern Maine, MEMaine | $868.35 | $592.96 |
| Detroit, MIMichigan | $913.12 | $644.95 |
| Rest of MichiganMichigan | $853.90 | $600.18 |
| MinnesotaMinnesota | $870.24 | $584.29 |
| Metropolitan Kansas City, MOMissouri | $859.50 | $598.55 |
| Metropolitan St. Louis, MOMissouri | $867.93 | $603.37 |
| Rest of MissouriMissouri | $817.64 | $578.09 |
| MississippiMississippi | $803.99 | $564.72 |
| MontanaMontana | $893.70 | $615.80 |
| North CarolinaNorth Carolina | $837.40 | $578.12 |
| North DakotaNorth Dakota | $860.68 | $582.78 |
| NebraskaNebraska | $817.42 | $560.93 |
| New HampshireNew Hampshire | $909.03 | $619.75 |
| Northern New JerseyNew Jersey | $1,002.92 | $680.56 |
| Rest of New JerseyNew Jersey | $960.89 | $657.43 |
| New MexicoNew Mexico | $860.08 | $605.25 |
| NevadaNevada | $885.03 | $606.86 |
| NYC suburbs and Long Island, NYNew York | $1,062.92 | $732.51 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $970.30 | $666.01 |
| Queens, NYNew York | $1,035.99 | $707.51 |
| Rest of New YorkNew York | $850.17 | $586.17 |
| OhioOhio | $847.15 | $593.43 |
| OklahomaOklahoma | $823.44 | $575.28 |
| Portland, OROregon | $944.37 | $635.63 |
| Rest of OregonOregon | $875.08 | $598.29 |
| Metropolitan Philadelphia, PAPennsylvania | $932.11 | $642.82 |
| Rest of PennsylvaniaPennsylvania | $846.34 | $591.24 |
| Puerto RicoPuerto Rico | $898.93 | $617.97 |
| Rhode IslandRhode Island | $911.29 | $624.22 |
| South CarolinaSouth Carolina | $844.29 | $587.52 |
| South DakotaSouth Dakota | $856.77 | $578.88 |
| TennesseeTennessee | $818.71 | $566.11 |
| Austin, TXTexas | $919.45 | $625.43 |
| Beaumont, TXTexas | $841.12 | $588.23 |
| Brazoria, TXTexas | $879.04 | $603.64 |
| Dallas, TXTexas | $886.39 | $609.61 |
| Fort Worth, TXTexas | $881.70 | $607.70 |
| Galveston, TXTexas | $882.80 | $606.85 |
| Houston, TXTexas | $913.36 | $637.41 |
| Rest of TexasTexas | $860.78 | $597.06 |
| UtahUtah | $855.63 | $594.41 |
| VirginiaVirginia | $868.20 | $595.03 |
| Virgin Islands, VIUnited States Virgin Islands | $898.93 | $617.97 |
| VermontVermont | $860.84 | $585.72 |
| Rest of WashingtonWashington | $913.03 | $620.40 |
| King County, WAWashington | $1,021.33 | $680.36 |
| WisconsinWisconsin | $832.47 | $566.24 |
| West VirginiaWest Virginia | $846.92 | $605.43 |
| WyomingWyoming | $879.31 | $601.41 |
19350 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$790.41
$1,052.26
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,052.26 | 1 |
| AL | $801.92 | 1 |
| AR | $790.41 | 1 |
| AZ | $868.99 | 1 |
| CA | $924.95–$1,139.86 | 29 |
| CO | $919.80 | 1 |
| CT | $953.14 | 1 |
| DC | $1,012.50 | 1 |
| DE | $883.16 | 1 |
| FL | $898.04–$1,001.29 | 3 |
| GA | $846.04–$914.57 | 2 |
| GU | $944.50 | 1 |
| HI | $944.50 | 1 |
| IA | $814.15 | 1 |
| ID | $821.10 | 1 |
| IL | $878.11–$970.83 | 4 |
| IN | $825.61 | 1 |
| KS | $814.16 | 1 |
| KY | $828.97 | 1 |
| LA | $829.20–$869.45 | 2 |
| MA | $915.93–$1,004.87 | 2 |
| MD | $898.70–$1,012.50 | 3 |
| ME | $829.41–$868.35 | 2 |
| MI | $853.90–$913.12 | 2 |
| MN | $870.24 | 1 |
| MO | $817.64–$867.93 | 3 |
| MS | $803.99 | 1 |
| MT | $893.70 | 1 |
| NC | $837.40 | 1 |
| ND | $860.68 | 1 |
| NE | $817.42 | 1 |
| NH | $909.03 | 1 |
| NJ | $960.89–$1,002.92 | 2 |
| NM | $860.08 | 1 |
| NV | $885.03 | 1 |
| NY | $850.17–$1,062.92 | 5 |
| OH | $847.15 | 1 |
| OK | $823.44 | 1 |
| OR | $875.08–$944.37 | 2 |
| PA | $846.34–$932.11 | 2 |
| PR | $898.93 | 1 |
| RI | $911.29 | 1 |
| SC | $844.29 | 1 |
| SD | $856.77 | 1 |
| TN | $818.71 | 1 |
| TX | $841.12–$919.45 | 8 |
| UT | $855.63 | 1 |
| VA | $868.20–$1,012.50 | 2 |
| VI | $898.93 | 1 |
| VT | $860.84 | 1 |
| WA | $913.03–$1,021.33 | 2 |
| WI | $832.47 | 1 |
| WV | $846.92 | 1 |
| WY | $879.31 | 1 |
How the 19350 rate is calculated
Each of 19350’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 · 19350
RVUs × geographic indexes × conversion factor
Work8.88
8.88 RVUs× 1.000 GPCI
Practice expense16.21
16.21 RVUs× 1.000 GPCI
Malpractice1.67
1.67 RVUs× 1.000 GPCI
Adjusted RVUs
26.7600
Conversion factor
$33.4009
Medicare rate
$893.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Santa Rosa, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,699
- Code
- 19350
- Physician work
- 8.88
- Practice expense
- 16.21
- Malpractice
- 1.67
GPCI2026.csv
31
- Locality
- Santa Rosa, CA
- Physician work
- 1.030
- Practice expense
- 1.228
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.88 | × 1.030 | 9.1464 |
| Practice expense | 16.21 | × 1.228 | 19.9059 |
| Malpractice | 1.67 | × 0.536 | 0.8951 |
| Total RVUs | 29.9474 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Santa Rosa, CA$1000.27
Office: (8.88 × 1.03 + 16.21 × 1.228 + 1.67 × 0.536) × $33.4009 = $1000.27
Facility: (8.88 × 1.03 + 7.89 × 1.228 + 1.67 × 0.536) × $33.4009 = $659.01
Payment rules and modifiers for 19350
19350 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19350
Nipple reconstruction, nipple–areola reconstruction
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 19350
Nipple reconstruction, nipple–areola reconstruction
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
19350 without 50 · national office
$893.81
Nipple reconstruction, nipple–areola reconstruction
19350-50 · Bilateral: 150%
$1,340.72
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).
How 19350 has changed in Santa Rosa, CA
19350 · Office / nonfacility
$1000.27
Effective 2026-10-01
The base rate is $94.19 higher than on 2025-10-01, moving from $906.08 to $1000.27 (10.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$906.08changed to$1000.27
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 9.11 changed to 8.88
- Practice expense RVU 14.37 changed to 16.21
- Malpractice RVU 1.70 changed to 1.67
- Work GPCI 1.027 changed to 1.030
- Practice expense GPCI 1.232 changed to 1.228
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$927.11changed to$906.08
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 14.24 changed to 14.37
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$911.98changed to$927.11
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$931.42changed to$911.98
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 14.18 changed to 14.24
- Malpractice RVU 1.66 changed to 1.70
- Work GPCI 1.036 changed to 1.027
- Practice expense GPCI 1.205 changed to 1.232
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$928.70changed to$931.42
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 13.86 changed to 14.18
- Malpractice RVU 1.68 changed to 1.66
- Work GPCI 1.045 changed to 1.036
- Practice expense GPCI 1.177 changed to 1.205
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$922.25changed to$928.70
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 13.78 changed to 13.86
- Malpractice RVU 1.62 changed to 1.68
- Work GPCI 1.042 changed to 1.045
- Practice expense GPCI 1.159 changed to 1.177
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$914.88changed to$922.25
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 13.10 changed to 13.78
- Malpractice RVU 1.61 changed to 1.62
- Work GPCI 1.038 changed to 1.042
- Practice expense GPCI 1.142 changed to 1.159
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$894.76changed to$914.88
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 12.94 changed to 13.10
- Malpractice RVU 1.56 changed to 1.61
- Work GPCI 1.024 changed to 1.038
- Practice expense GPCI 1.130 changed to 1.142
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$883.20changed to$894.76
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 12.91 changed to 12.94
- Malpractice RVU 1.55 changed to 1.56
- Work GPCI 1.023 changed to 1.024
- Practice expense GPCI 1.111 changed to 1.130
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$873.40changed to$883.20
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 12.86 changed to 12.91
- Malpractice RVU 1.56 changed to 1.55
- Work GPCI 1.024 changed to 1.023
- Practice expense GPCI 1.093 changed to 1.111
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$873.40
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,000.27 | $659.01 | RVU26D |
| 2026-07-01 | $1,000.27 | $659.01 | RVU26C |
| 2026-04-01 | $1,000.27 | $659.01 | RVU26B |
| 2026-01-01 | $1,000.27 | $659.01 | RVU26A |
| 2025-10-01 | $906.08 | $719.58 | RVU25D |
| 2025-07-01 | $906.08 | $719.58 | RVU25C |
| 2025-04-01 | $906.08 | $719.58 | RVU25B |
| 2025-01-01 | $906.08 | $719.58 | RVU25A |
| 2024-10-01 | $927.11 | $731.90 | RVU24D |
| 2024-07-01 | $927.11 | $731.90 | RVU24C |
| 2024-04-01 | $927.11 | $731.90 | RVU24B |
| 2024-03-09 | $927.11 | $731.90 | RVU24AR |
| 2024-01-01 | $911.98 | $719.96 | RVU24A |
| 2023-10-01 | $931.42 | $736.65 | RVU23D |
| 2023-07-01 | $931.42 | $736.65 | RVU23C |
| 2023-04-01 | $931.42 | $736.65 | RVU23B |
| 2023-01-01 | $931.42 | $736.65 | RVU23A |
| 2022-10-01 | $928.70 | $735.22 | RVU22D |
| 2022-07-01 | $928.70 | $735.22 | RVU22C |
| 2022-04-01 | $928.70 | $735.22 | RVU22B |
| 2022-01-01 | $928.70 | $735.22 | RVU22A |
| 2021-10-01 | $922.25 | $728.94 | RVU21D |
| 2021-07-01 | $922.25 | $728.94 | RVU21C |
| 2021-04-01 | $922.25 | $728.94 | RVU21B |
| 2021-01-01 | $922.25 | $728.94 | RVU21A |
| 2020-10-01 | $914.88 | $733.95 | RVU20D |
| 2020-07-01 | $914.88 | $733.95 | RVU20C |
| 2020-04-01 | $914.88 | $733.95 | RVU20B |
| 2020-01-01 | $914.88 | $733.95 | RVU20A |
| 2019-10-01 | $894.76 | $719.65 | RVU19D |
| 2019-07-01 | $894.76 | $719.65 | RVU19C |
| 2019-04-01 | $894.76 | $719.65 | RVU19B |
| 2019-01-01 | $894.76 | $719.65 | RVU19A |
| 2018-10-01 | $883.20 | $713.62 | RVU18D |
| 2018-07-01 | $883.20 | $713.62 | RVU18C |
| 2018-04-01 | $883.20 | $713.62 | RVU18B |
| 2018-01-01 | $883.20 | $713.62 | RVU18AR1 |
| 2017-10-01 | $873.40 | $709.82 | RVU17D |
| 2017-07-01 | $873.40 | $709.82 | RVU17C |
| 2017-04-01 | $873.40 | $709.82 | RVU17B |
| 2017-01-01 | $873.40 | $709.82 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Santa Rosa, CA rate applies
Santa Rosa, CA is a Medicare payment area, not a city. Our Census mapping connects it to 38 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Petaluma
- Santa Rosa
- Bloomfield
- Bodega
- Bodega Bay
- Boyes Hot Springs
- Carmet
- Cazadero
19350 billing questions
How is 19350 different from 19355?
19350 is for reconstructing the nipple and areola, usually after mastectomy. 19355 addresses an inverted nipple rather than creating a nipple–areola complex.
When should a broader breast revision be reported instead?
Use 19380 when the documented work revises the reconstructed breast more broadly, such as its contour or overall reconstruction. Use 19350 for nipple-and-areola reconstruction.
Does 19350 include the breast mound reconstruction?
No. It describes nipple-and-areola reconstruction; breast mound reconstruction is a separate service when performed and supported by the operative documentation.
How should bilateral reconstruction be reported?
CMS identifies 19350 as a bilateral procedure: reporting modifier 50 results in payment at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care. The operative note should support the reconstructive work and the postoperative record should reflect care related to that surgery.
Can an assistant or co-surgeon be paid for this procedure?
CMS applies a statutory restriction on assistant-at-surgery payment for 19350. Co-surgeons and team surgery are 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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