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

Corrects an inverted nipple by surgery when eversion is the operative goal, rather than reconstruction of a missing nipple or broader breast surgery.

CMS RVU26DEffective Oct 1, 2026One payment locality37 Medicare services in 2024

In Connecticut, Medicare pays $867.63 for 19355 in the office and $596.40 when it’s performed in a hospital or facility.

$867.63Office (non-facility)
$596.40Hospital or facility
+6.6%vs the national office rate ($813.98)

Check a contract rate as a % of Medicare · 19355 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 19355 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 19355 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 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.

How Connecticut compares for 19355

Across 109 of 109 payment localities, the office rate for 19355 runs from $720.77 in Arkansas to $1,035.31 in San Benito County, CA. Connecticut pays $867.63. The RVUs are the same everywhere; the geographic indexes change the dollars.

19355 in Connecticut vs other payment areas
  1. Connecticut · this page$867.63
  2. Los Angeles, CA · California$897.00+$29.37
  3. Washington, DC area · District of Columbia$921.13+$53.50
  4. Miami, FL · Florida$912.01+$44.38
  5. Chicago, IL · Illinois$884.53+$16.90
  6. Manhattan, NY · New York$940.31+$72.68
  7. Alaska · Alaska$961.36+$93.73

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

Every other payment area

19355 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$731.14$510.77
ArkansasArkansas$720.77$504.43
ArizonaArizona$791.58$547.54
Bakersfield, CACalifornia$845.86$569.84
Chico, CACalifornia$841.58$565.56
El Centro, CACalifornia$841.83$565.81
Fresno, CACalifornia$841.58$565.56
Hanford, CACalifornia$841.58$565.56

19355 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.

$720.77

$961.36

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

View every state and territory as a table
19355 office rate range by state
State / territoryOffice rate rangeLocalities
AK$961.361
AL$731.141
AR$720.771
AZ$791.581
CA$841.58–$1,035.3129
CO$837.181
CT$867.631
DC$921.131
DE$804.381
FL$818.33–$912.013
GA$771.38–$832.852
GU$858.951
HI$858.951
IA$741.911
ID$748.221
IL$800.53–$884.534
IN$752.281
KS$742.041
KY$755.771
LA$756.02–$792.302
MA$833.77–$913.892
MD$818.39–$921.133
ME$755.84–$790.752
MI$778.35–$832.052
MN$792.081
MO$745.68–$790.793
MS$733.181
MT$813.881
NC$763.021
ND$783.621
NE$744.821
NH$827.491
NJ$874.69–$912.592
NM$783.971
NV$805.931
NY$774.54–$967.265
OH$772.171
OK$750.661
OR$796.86–$859.212
PA$771.37–$848.742
PR$818.551
RI$829.751
SC$769.431
SD$780.051
TN$746.161
TX$766.67–$836.868
UT$779.651
VA$790.71–$921.132
VI$818.551
VT$783.881
WA$831.10–$928.672
WI$758.231
WV$772.431
WY$800.691

See 19355 in every payment locality

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.

How the rate is built · 19355

RVUs × geographic indexes × conversion factor

Office or facility?

Work8.31

8.31 RVUs× 1.000 GPCI

Practice expense14.53

14.53 RVUs× 1.000 GPCI

Malpractice1.53

1.53 RVUs× 1.000 GPCI

Adjusted RVUs

24.3700

Conversion factor

$33.4009

Medicare rate

$813.98

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

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,700

Code
19355
Physician work
8.31
Practice expense
14.53
Malpractice
1.53

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 19355 in Connecticut
ComponentRVULocality factorAdjusted
Physician work8.31× 1.0208.4762
Practice expense14.53× 1.07715.6488
Malpractice1.53× 1.2101.8513
Total RVUs25.9763
Conversion factor× 33.4009

Office rate, Connecticut$867.63

Office: (8.31 × 1.02 + 14.53 × 1.077 + 1.53 × 1.21) × $33.4009 = $867.63

Facility: (8.31 × 1.02 + 6.99 × 1.077 + 1.53 × 1.21) × $33.4009 = $596.40

Open 19355 in the RVU calculator

Payment rules and modifiers for 19355

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

CMS payment indicators · 19355

Nipple correction, existing inverted nipple

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)0Not paid without supporting documentation.
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 · 19355

Nipple correction, existing inverted nipple

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

19355 without 50 · national office

$813.98

Nipple correction, existing inverted nipple

19355-50 · Bilateral: 150%

$1,220.97

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 19355

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

Codes related to 19355
CodeHow it relatesOffice range, Connecticut
Used instead
19350Nipple reconstruction, nipple–areola reconstructionRelated nipple surgery; used for nipple or areola reconstruction rather than correcting an existing inverted nipple.$953.14

How 19355 has changed in Connecticut

19355 · Office / nonfacility

$867.63

Effective 2026-10-01

The base rate is $73.36 higher than on 2025-10-01, moving from $794.27 to $867.63 (9.2%).

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

    $794.27changed to$867.63

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 8.52 changed to 8.31
    • Practice expense RVU 12.80 changed to 14.53
    • Malpractice RVU 1.56 changed to 1.53
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $813.06changed to$794.27

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 12.67 changed to 12.80
    • Malpractice RVU 1.57 changed to 1.56

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $799.79changed to$813.06

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $825.62changed to$799.79

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 12.65 changed to 12.67
    • Malpractice RVU 1.54 changed to 1.57
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $833.12changed to$825.62

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 12.38 changed to 12.65
    • Malpractice RVU 1.55 changed to 1.54
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $836.39changed to$833.12

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 12.32 changed to 12.38
    • Malpractice RVU 1.51 changed to 1.55

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $847.19changed to$836.39

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 11.74 changed to 12.32
    • Malpractice RVU 1.50 changed to 1.51
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $843.51changed to$847.19

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 11.60 changed to 11.74
    • Malpractice RVU 1.44 changed to 1.50
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $842.15changed to$843.51

    • Malpractice RVU 1.41 changed to 1.44

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $842.23changed to$842.15

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 11.58 changed to 11.60
    • Malpractice RVU 1.45 changed to 1.41

    Held through RVU19B.

  11. January 1, 2018

    RVU18AR1

    $779.37changed to$842.23

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.40 changed to 11.58
    • Malpractice RVU 2.01 changed to 1.45
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $785.82changed to$779.37

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.51 changed to 9.40
    • Malpractice RVU 2.08 changed to 2.01
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $786.49changed to$785.82

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.50 changed to 9.51
    • Malpractice RVU 2.04 changed to 2.08

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $782.57changed to$786.49

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $768.05changed to$782.57

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.47 changed to 9.50
    • Malpractice RVU 1.74 changed to 2.04
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $777.02changed to$768.05

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.69 changed to 9.47
    • Malpractice RVU 1.82 changed to 1.74
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $777.02

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$867.63$596.40RVU26D
2026-07-01$867.63$596.40RVU26C
2026-04-01$867.63$596.40RVU26B
2026-01-01$867.63$596.40RVU26A
2025-10-01$794.27$649.58RVU25D
2025-07-01$794.27$649.58RVU25C
2025-04-01$794.27$649.58RVU25B
2025-01-01$794.27$649.58RVU25A
2024-10-01$813.06$661.62RVU24D
2024-07-01$813.06$661.62RVU24C
2024-04-01$813.06$661.62RVU24B
2024-03-09$813.06$661.62RVU24AR
2024-01-01$799.79$650.82RVU24A
2023-10-01$825.62$668.40RVU23D
2023-07-01$825.62$668.40RVU23C
2023-04-01$825.62$668.40RVU23B
2023-01-01$825.62$668.40RVU23A
2022-10-01$833.12$670.82RVU22D
2022-07-01$833.12$670.82RVU22C
2022-04-01$833.12$670.82RVU22B
2022-01-01$833.12$670.82RVU22A
2021-10-01$836.39$671.97RVU21D
2021-07-01$836.39$671.97RVU21C
2021-04-01$836.39$671.97RVU21B
2021-01-01$836.39$671.97RVU21A
2020-10-01$847.19$691.74RVU20D
2020-07-01$847.19$691.74RVU20C
2020-04-01$847.19$691.74RVU20B
2020-01-01$847.19$691.74RVU20A
2019-10-01$843.51$692.42RVU19D
2019-07-01$843.51$692.42RVU19C
2019-04-01$842.15$691.07RVU19B
2019-01-01$842.15$691.07RVU19A
2018-10-01$842.23$694.12RVU18D
2018-07-01$842.23$694.12RVU18C
2018-04-01$842.23$694.12RVU18B
2018-01-01$842.23$694.12RVU18AR1
2017-10-01$779.37$637.46RVU17D
2017-07-01$779.37$637.46RVU17C
2017-04-01$779.37$637.46RVU17B
2017-01-01$779.37$637.46RVU17A
2016-10-01$785.82$639.73RVU16D
2016-07-01$785.82$639.73RVU16C
2016-04-01$785.82$639.73RVU16B
2016-01-01$785.82$639.73RVU16A
2015-10-01$786.49$639.46RVU15D
2015-07-01$786.49$639.46RVU15C
2015-04-01$782.57$636.28RVU15B
2015-01-01$782.57$636.28RVU15A
2014-10-01$768.05$624.12RVU14D
2014-07-01$768.05$624.12RVU14C
2014-04-01$768.05$624.12RVU14B
2014-01-01$768.05$624.12RVU14A
2013-10-01$777.02$621.43RVU13D
2013-07-01$777.02$621.43RVU13C
2013-04-01$777.02$621.43RVU13B
2013-01-01$777.02$621.43RVU13AR

Price 19355 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

19355 billing questions

When should 19355 be chosen over 19350?

Use 19355 to correct an existing inverted nipple. Code 19350 concerns nipple or areola reconstruction, such as reconstruction when the nipple is absent.

How is bilateral correction reported?

For correction on both sides, report modifier 50 under the CMS bilateral rule. The CMS payment rule for this code is 150% for a bilateral procedure with modifier 50.

What documentation supports 19355?

Document the nipple inversion, side treated, the operative correction, and whether one or both nipples were treated. Include the operative goal when another breast procedure is performed in the same session.

Are related postoperative visits included?

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

Can an assistant surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.

How does payment work when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 19355PPRRVU2026_Oct_nonQPP.csv, line 1,700 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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