CPT code 19355: Nipple correction, existing inverted nipple2026 Medicare rate & RVUs

Medicare pays $813.98 for 19355 nationally in the office and $562.14 in a hospital or facility. Local office rates run $720.77–$1,035.31.

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

What 19355 covers

This operation corrects an existing nipple that turns inward. A breast or plastic surgeon typically performs it in an operating-room setting, often for persistent inversion associated with symptoms or functional concerns. The operative goal is to evert the nipple, not to create a nipple after mastectomy or to reshape the breast. The technique varies, so the operative report should establish the condition treated and the correction performed.

Report 19355 for the nipple-correction service, identifying the treated side and using modifier 50 when performed bilaterally under the CMS bilateral rule. The record should document the inversion, laterality, operative work, and any separate breast procedure performed in the same session. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment requires documented medical necessity; 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.

Where 19355 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

19355 rates by state

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

How the 19355 rate is calculated

Each of 19355’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.

Payment rules and modifiers for 19355

19355 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

19355 compared with similar codes

How to choose

19350Nipple reconstructionNipple–areola reconstruction

19355 corrects inversion of an existing nipple. 19350 addresses nipple or areola reconstruction, such as when the nipple is absent.

19316Breast liftPtosis correction

19316 is a breast lift for ptosis. It is not the code for an operation whose goal is correction of nipple inversion.

19318Breast reductionTissue removal and reshaping

19318 addresses breast reduction. Choose 19355 when the operative target is an inverted nipple, not breast size.

Codes related to 19355

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

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

Open CMS sourceHow we calculate rates