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CPT code 19350: Nipple reconstruction, nipple–areola reconstruction2026 Medicare rate & RVUs in Puerto Rico

Reports surgical reconstruction of the nipple and areola, commonly as a later stage of breast reconstruction after mastectomy.

CMS RVU26DEffective Oct 1, 2026One payment locality776 Medicare services in 2024

In Puerto Rico, Medicare pays $898.93 for 19350 in the office and $617.97 when it’s performed in a hospital or facility.

$898.93Office (non-facility)
$617.97Hospital or facility
+0.6%vs the national office rate ($893.81)

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.

We’ll open 19350 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 19350 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Puerto Rico 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. Puerto Rico pays $898.93. The RVUs are the same everywhere; the geographic indexes change the dollars.

19350 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$898.93
  2. Los Angeles, CA · California$986.31+$87.38
  3. Washington, DC area · District of Columbia$1,012.50+$113.57
  4. Miami, FL · Florida$1,001.29+$102.36
  5. Chicago, IL · Illinois$970.83+$71.90
  6. Manhattan, NY · New York$1,033.19+$134.26
  7. Alaska · Alaska$1,052.26+$153.33

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

19350 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$801.92$558.76
ArkansasArkansas$790.41$551.70
ArizonaArizona$868.99$599.71
Bakersfield, CACalifornia$929.61$625.04
Chico, CACalifornia$924.95$620.37
El Centro, CACalifornia$925.22$620.65
Fresno, CACalifornia$924.95$620.37
Hanford, CACalifornia$924.95$620.37

19350 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.

$790.41

$1,052.26

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
19350 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,052.261
AL$801.921
AR$790.411
AZ$868.991
CA$924.95–$1,139.8629
CO$919.801
CT$953.141
DC$1,012.501
DE$883.161
FL$898.04–$1,001.293
GA$846.04–$914.572
GU$944.501
HI$944.501
IA$814.151
ID$821.101
IL$878.11–$970.834
IN$825.611
KS$814.161
KY$828.971
LA$829.20–$869.452
MA$915.93–$1,004.872
MD$898.70–$1,012.503
ME$829.41–$868.352
MI$853.90–$913.122
MN$870.241
MO$817.64–$867.933
MS$803.991
MT$893.701
NC$837.401
ND$860.681
NE$817.421
NH$909.031
NJ$960.89–$1,002.922
NM$860.081
NV$885.031
NY$850.17–$1,062.925
OH$847.151
OK$823.441
OR$875.08–$944.372
PA$846.34–$932.112
PR$898.931
RI$911.291
SC$844.291
SD$856.771
TN$818.711
TX$841.12–$919.458
UT$855.631
VA$868.20–$1,012.502
VI$898.931
VT$860.841
WA$913.03–$1,021.332
WI$832.471
WV$846.921
WY$879.311

See 19350 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 19350 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work8.88× 1.0008.8800
Practice expense16.21× 1.01116.3883
Malpractice1.67× 0.9851.6449
Total RVUs26.9133
Conversion factor× 33.4009

Office rate, Puerto Rico$898.93

Office: (8.88 × 1 + 16.21 × 1.011 + 1.67 × 0.985) × $33.4009 = $898.93

Facility: (8.88 × 1 + 7.89 × 1.011 + 1.67 × 0.985) × $33.4009 = $617.97

Open 19350 in the RVU calculator

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

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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
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 · 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.

  • 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

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).

When to use modifier 50

Codes related to 19350

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

Codes related to 19350
CodeHow it relatesOffice range, Puerto Rico
Used instead
19355Nipple correction, existing inverted nippleFor correction of an inverted nipple, rather than nipple-and-areola reconstruction.$818.55
19380Breast revision, reconstructed breastFor revision of a reconstructed breast when the work extends beyond nipple-and-areola reconstruction.No office rate
Often billed with
19357Breast reconstruction, tissue expander placementMay be reported in the same session when expander placement and nipple–areola reconstruction are both performed.No office rate

How 19350 has changed in Puerto Rico

19350 · Office / nonfacility

$898.93

Effective 2026-10-01

The base rate is $82.18 higher than on 2025-10-01, moving from $816.75 to $898.93 (10.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $816.75changed to$898.93

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $836.15changed to$816.75

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 14.24 changed to 14.37

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $822.50changed to$836.15

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $848.43changed to$822.50

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $845.49changed to$848.43

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $856.07changed to$845.49

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $858.29changed to$856.07

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $862.74changed to$858.29

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $853.59changed to$862.74

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $851.21changed to$853.59

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $757.96changed to$851.21

    • 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
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $665.09changed to$757.96

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 12.77 changed to 12.86
    • Malpractice RVU 1.58 changed to 1.56
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $667.68changed to$665.09

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 12.79 changed to 12.77
    • Malpractice RVU 1.55 changed to 1.58

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $664.36changed to$667.68

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $656.43changed to$664.36

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 12.65 changed to 12.79
    • Malpractice RVU 1.70 changed to 1.55
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $647.05changed to$656.43

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 13.96 changed to 12.65
    • Malpractice RVU 1.78 changed to 1.70
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $647.05

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$898.93$617.97RVU26D
2026-07-01$898.93$617.97RVU26C
2026-04-01$898.93$617.97RVU26B
2026-01-01$898.93$617.97RVU26A
2025-10-01$816.75$664.31RVU25D
2025-07-01$816.75$664.31RVU25C
2025-04-01$816.75$664.31RVU25B
2025-01-01$816.75$664.31RVU25A
2024-10-01$836.15$676.59RVU24D
2024-07-01$836.15$676.59RVU24C
2024-04-01$836.15$676.59RVU24B
2024-03-09$836.15$676.59RVU24AR
2024-01-01$822.50$665.55RVU24A
2023-10-01$848.43$685.49RVU23D
2023-07-01$845.49$683.84RVU23C
2023-04-01$845.49$683.84RVU23B
2023-01-01$845.49$683.84RVU23A
2022-10-01$856.07$690.37RVU22D
2022-07-01$856.07$690.37RVU22C
2022-04-01$856.07$690.37RVU22B
2022-01-01$856.07$690.37RVU22A
2021-10-01$858.29$690.16RVU21D
2021-07-01$858.29$690.16RVU21C
2021-04-01$858.29$690.16RVU21B
2021-01-01$858.29$690.16RVU21A
2020-10-01$862.74$703.04RVU20D
2020-07-01$862.74$703.04RVU20C
2020-04-01$862.74$703.04RVU20B
2020-01-01$862.74$703.04RVU20A
2019-10-01$853.59$697.53RVU19D
2019-07-01$853.59$697.53RVU19C
2019-04-01$853.59$697.53RVU19B
2019-01-01$853.59$697.53RVU19A
2018-10-01$851.21$697.50RVU18D
2018-07-01$851.21$697.50RVU18C
2018-04-01$851.21$697.50RVU18B
2018-01-01$851.21$697.50RVU18AR1
2017-10-01$757.96$629.85RVU17D
2017-07-01$757.96$629.85RVU17C
2017-04-01$757.96$629.85RVU17B
2017-01-01$757.96$629.85RVU17A
2016-10-01$665.09$560.09RVU16D
2016-07-01$665.09$560.09RVU16C
2016-04-01$665.09$560.09RVU16B
2016-01-01$665.09$560.09RVU16A
2015-10-01$667.68$562.04RVU15D
2015-07-01$667.68$562.04RVU15C
2015-04-01$664.36$559.25RVU15B
2015-01-01$664.36$559.25RVU15A
2014-10-01$656.43$555.29RVU14D
2014-07-01$656.43$555.29RVU14C
2014-04-01$656.43$555.29RVU14B
2014-01-01$656.43$555.29RVU14A
2013-10-01$647.05$540.94RVU13D
2013-07-01$647.05$540.94RVU13C
2013-04-01$647.05$540.94RVU13B
2013-01-01$647.05$540.94RVU13AR

Price 19350 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 19350PPRRVU2026_Oct_nonQPP.csv, line 1,699 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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