CPT code 19357: Breast reconstruction, tissue expander placement2026 Medicare rate & RVUs in North Carolina
Placement of a breast tissue expander for immediate or delayed reconstruction, with planned subsequent expansion included in the reconstruction service.
In North Carolina, Medicare pays $1,006.63 for 19357 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 19357 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 19357 covers
A plastic or reconstructive surgeon places a temporary, inflatable device in the breast pocket to create or restore breast volume after mastectomy. Placement may be performed during the mastectomy operation or as a delayed reconstruction. The patient typically returns for staged expansion as the device is filled over time, before a later reconstructive step such as implant exchange.
Report 19357 for the expander-based reconstruction, not again for each planned fill. Documentation should identify the reconstructed side, whether reconstruction is immediate or delayed, and the operative work establishing the expander. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For bilateral work, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. An assistant at surgery may be paid; co-surgeons require 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.
How North Carolina compares for 19357
Across 109 of 109 payment localities, the facility rate for 19357 runs from $958.46 in Arkansas to $1,306.11 in Alaska. North Carolina pays $1,006.63. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$1,006.63
- Los Angeles, CA · California$1,153.38+$146.75
- Washington, DC area · District of Columbia$1,197.97+$191.34
- Miami, FL · Florida$1,232.19+$225.56
- Chicago, IL · Illinois$1,196.36+$189.73
- Manhattan, NY · New York$1,237.79+$231.16
- Alaska · Alaska$1,306.11+$299.48
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $971.07 |
| ArkansasArkansas | — | $958.46 |
| ArizonaArizona | — | $1,044.30 |
| Bakersfield, CACalifornia | — | $1,094.37 |
| Chico, CACalifornia | — | $1,086.77 |
| El Centro, CACalifornia | — | $1,087.23 |
| Fresno, CACalifornia | — | $1,086.77 |
| Hanford, CACalifornia | — | $1,086.77 |
| Madera, CACalifornia | — | $1,086.77 |
| Merced, CACalifornia | — | $1,086.77 |
| Modesto, CACalifornia | — | $1,086.77 |
| Napa, CACalifornia | — | $1,217.17 |
| Oxnard, CACalifornia | — | $1,142.88 |
| Redding, CACalifornia | — | $1,086.77 |
| Rest of CaliforniaCalifornia | — | $1,086.77 |
| Riverside, CACalifornia | — | $1,116.05 |
| Sacramento, CACalifornia | — | $1,129.37 |
| Salinas, CACalifornia | — | $1,124.95 |
| San Diego, CACalifornia | — | $1,143.47 |
| Marin County, CACalifornia | — | $1,274.06 |
| San Francisco, CACalifornia | — | $1,270.97 |
| San Benito County, CACalifornia | — | $1,304.26 |
| Santa Clara County, CACalifornia | — | $1,291.63 |
| San Luis Obispo, CACalifornia | — | $1,108.21 |
| Santa Cruz, CACalifornia | — | $1,148.05 |
| Santa Maria, CACalifornia | — | $1,127.00 |
| Santa Rosa, CACalifornia | — | $1,158.88 |
| Stockton, CACalifornia | — | $1,086.77 |
| Vallejo, CACalifornia | — | $1,212.71 |
| Visalia, CACalifornia | — | $1,086.77 |
| Yuba City, CACalifornia | — | $1,086.77 |
| ColoradoColorado | — | $1,090.66 |
| ConnecticutConnecticut | — | $1,139.98 |
| DelawareDelaware | — | $1,060.09 |
| Fort Lauderdale, FLFlorida | — | $1,152.73 |
| Rest of FloridaFlorida | — | $1,096.59 |
| Atlanta, GAGeorgia | — | $1,100.53 |
| Rest of GeorgiaGeorgia | — | $1,036.42 |
| Hawaii, Guam, HIHawaii | — | $1,102.91 |
| IowaIowa | — | $975.67 |
| IdahoIdaho | — | $985.06 |
| East St. Louis, ILIllinois | — | $1,125.07 |
| Rest of IllinoisIllinois | — | $1,080.60 |
| Suburban Chicago, ILIllinois | — | $1,159.82 |
| IndianaIndiana | — | $989.74 |
| KansasKansas | — | $979.90 |
| KentuckyKentucky | — | $1,009.76 |
| New Orleans, LALouisiana | — | $1,055.77 |
| Rest of LouisianaLouisiana | — | $1,011.67 |
| Metropolitan Boston, MAMassachusetts | — | $1,179.40 |
| Rest of MassachusettsMassachusetts | — | $1,088.56 |
| Baltimore area, MDMaryland | — | $1,138.50 |
| Rest of MarylandMaryland | — | $1,076.20 |
| Rest of MaineMaine | — | $998.60 |
| Southern Maine, MEMaine | — | $1,034.83 |
| Detroit, MIMichigan | — | $1,117.71 |
| Rest of MichiganMichigan | — | $1,041.17 |
| MinnesotaMinnesota | — | $1,023.34 |
| Metropolitan Kansas City, MOMissouri | — | $1,040.33 |
| Metropolitan St. Louis, MOMissouri | — | $1,049.08 |
| Rest of MissouriMissouri | — | $1,001.66 |
| MississippiMississippi | — | $979.81 |
| MontanaMontana | — | $1,072.66 |
| North DakotaNorth Dakota | — | $1,018.87 |
| NebraskaNebraska | — | $977.93 |
| New HampshireNew Hampshire | — | $1,081.93 |
| Northern New JerseyNew Jersey | — | $1,189.25 |
| Rest of New JerseyNew Jersey | — | $1,146.86 |
| New MexicoNew Mexico | — | $1,049.71 |
| NevadaNevada | — | $1,058.16 |
| NYC suburbs and Long Island, NYNew York | — | $1,275.88 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,161.04 |
| Queens, NYNew York | — | $1,234.68 |
| Rest of New YorkNew York | — | $1,020.92 |
| OhioOhio | — | $1,030.18 |
| OklahomaOklahoma | — | $999.22 |
| Portland, OROregon | — | $1,112.67 |
| Rest of OregonOregon | — | $1,043.86 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,119.52 |
| Rest of PennsylvaniaPennsylvania | — | $1,026.95 |
| Puerto RicoPuerto Rico | — | $1,076.96 |
| Rhode IslandRhode Island | — | $1,088.66 |
| South CarolinaSouth Carolina | — | $1,021.31 |
| South DakotaSouth Dakota | — | $1,012.51 |
| TennesseeTennessee | — | $985.39 |
| Austin, TXTexas | — | $1,092.37 |
| Beaumont, TXTexas | — | $1,021.51 |
| Brazoria, TXTexas | — | $1,052.23 |
| Dallas, TXTexas | — | $1,062.29 |
| Fort Worth, TXTexas | — | $1,058.49 |
| Galveston, TXTexas | — | $1,057.59 |
| Houston, TXTexas | — | $1,107.37 |
| Rest of TexasTexas | — | $1,038.59 |
| UtahUtah | — | $1,033.65 |
| VirginiaVirginia | — | $1,037.65 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,076.96 |
| VermontVermont | — | $1,022.97 |
| Rest of WashingtonWashington | — | $1,083.84 |
| King County, WAWashington | — | $1,193.58 |
| WisconsinWisconsin | — | $989.02 |
| West VirginiaWest Virginia | — | $1,046.67 |
| WyomingWyoming | — | $1,049.22 |
19357 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.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 19357 rate is calculated
Each of 19357’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 · 19357
RVUs × geographic indexes × conversion factor
Work14.47
14.47 RVUs× 1.000 GPCI
Practice expense14.93
14.93 RVUs× 1.000 GPCI
Malpractice2.72
2.72 RVUs× 1.000 GPCI
Adjusted RVUs
32.1200
Conversion factor
$33.4009
Medicare rate
$1,072.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,701
- Code
- 19357
- Physician work
- 14.47
- Practice expense
- 14.93
- Malpractice
- 2.72
GPCI2026.csv
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.47 | × 1.000 | 14.4700 |
| Practice expense | 14.93 | × 0.933 | 13.9297 |
| Malpractice | 2.72 | × 0.639 | 1.7381 |
| Total RVUs | 30.1378 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, North Carolina$1006.63
Facility: (14.47 × 1 + 14.93 × 0.933 + 2.72 × 0.639) × $33.4009 = $1006.63
Payment rules and modifiers for 19357
19357 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19357
Breast reconstruction, tissue expander placement
| 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 · 19357
Breast reconstruction, tissue expander placement
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
19357 without 50 · national facility
$1,072.84
Breast reconstruction, tissue expander placement
19357-50 · Bilateral: 150%
$1,609.26
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 19357 has changed in North Carolina
19357 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1,006.63 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,006.63 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,006.63 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,006.63 | RVU26A |
| 2025-10-01 | Not available in this setting | $1,068.44 | RVU25D |
| 2025-07-01 | Not available in this setting | $1,068.44 | RVU25C |
| 2025-04-01 | Not available in this setting | $1,068.44 | RVU25B |
| 2025-01-01 | Not available in this setting | $1,068.44 | RVU25A |
| 2024-10-01 | Not available in this setting | $1,088.39 | RVU24D |
| 2024-07-01 | Not available in this setting | $1,088.39 | RVU24C |
| 2024-04-01 | Not available in this setting | $1,088.39 | RVU24B |
| 2024-03-09 | Not available in this setting | $1,088.39 | RVU24AR |
| 2024-01-01 | Not available in this setting | $1,070.62 | RVU24A |
| 2023-10-01 | Not available in this setting | $1,110.08 | RVU23D |
| 2023-07-01 | Not available in this setting | $1,110.08 | RVU23C |
| 2023-04-01 | Not available in this setting | $1,110.08 | RVU23B |
| 2023-01-01 | Not available in this setting | $1,110.08 | RVU23A |
| 2022-10-01 | Not available in this setting | $1,128.51 | RVU22D |
| 2022-07-01 | Not available in this setting | $1,128.51 | RVU22C |
| 2022-04-01 | Not available in this setting | $1,128.51 | RVU22B |
| 2022-01-01 | Not available in this setting | $1,128.51 | RVU22A |
| 2021-10-01 | Not available in this setting | $1,134.47 | RVU21D |
| 2021-07-01 | Not available in this setting | $1,134.47 | RVU21C |
| 2021-04-01 | Not available in this setting | $1,134.47 | RVU21B |
| 2021-01-01 | Not available in this setting | $1,134.47 | RVU21A |
| 2020-10-01 | Not available in this setting | $1,482.02 | RVU20D |
| 2020-07-01 | Not available in this setting | $1,482.02 | RVU20C |
| 2020-04-01 | Not available in this setting | $1,482.02 | RVU20B |
| 2020-01-01 | Not available in this setting | $1,482.02 | RVU20A |
| 2019-10-01 | Not available in this setting | $1,467.33 | RVU19D |
| 2019-07-01 | Not available in this setting | $1,467.33 | RVU19C |
| 2019-04-01 | Not available in this setting | $1,467.33 | RVU19B |
| 2019-01-01 | Not available in this setting | $1,467.33 | RVU19A |
| 2018-10-01 | Not available in this setting | $1,469.58 | RVU18D |
| 2018-07-01 | Not available in this setting | $1,469.58 | RVU18C |
| 2018-04-01 | Not available in this setting | $1,469.58 | RVU18B |
| 2018-01-01 | Not available in this setting | $1,469.58 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $1,469.07 | RVU17D |
| 2017-07-01 | Not available in this setting | $1,469.07 | RVU17C |
| 2017-04-01 | Not available in this setting | $1,469.07 | RVU17B |
| 2017-01-01 | Not available in this setting | $1,469.07 | RVU17A |
| 2016-10-01 | Not available in this setting | $1,464.73 | RVU16D |
| 2016-07-01 | Not available in this setting | $1,464.73 | RVU16C |
| 2016-04-01 | Not available in this setting | $1,464.73 | RVU16B |
| 2016-01-01 | Not available in this setting | $1,464.73 | RVU16A |
| 2015-10-01 | Not available in this setting | $1,468.36 | RVU15D |
| 2015-07-01 | Not available in this setting | $1,468.36 | RVU15C |
| 2015-04-01 | Not available in this setting | $1,461.05 | RVU15B |
| 2015-01-01 | Not available in this setting | $1,461.05 | RVU15A |
| 2014-10-01 | Not available in this setting | $1,462.30 | RVU14D |
| 2014-07-01 | Not available in this setting | $1,462.30 | RVU14C |
| 2014-04-01 | Not available in this setting | $1,462.30 | RVU14B |
| 2014-01-01 | Not available in this setting | $1,462.30 | RVU14A |
| 2013-10-01 | Not available in this setting | $1,452.10 | RVU13D |
| 2013-07-01 | Not available in this setting | $1,452.10 | RVU13C |
| 2013-04-01 | Not available in this setting | $1,452.10 | RVU13B |
| 2013-01-01 | Not available in this setting | $1,452.10 | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
19357 billing questions
When is 19357 used instead of direct implant placement?
Use 19357 when reconstruction is staged with a tissue expander. Direct implant placement at the mastectomy operation is represented by 19340.
Can each expander-fill visit be billed as 19357?
No. Planned subsequent expansion is included in the reconstruction service; 19357 is not reported again for each fill.
Can 19357 be reported with a mastectomy code?
It may be performed in the same session as a mastectomy when immediate reconstruction is planned. The CMS multiple-procedure reduction applies to procedures performed in the same session.
How is bilateral expander placement reported?
For bilateral work, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Planned expander expansion is also part of the reconstruction service.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is 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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