CPT code 19361: Breast reconstruction, latissimus dorsi flap2026 Medicare rate & RVUs in Missouri
Reports breast reconstruction using a latissimus dorsi flap moved from the back to the chest, commonly after mastectomy.
CMS doesn’t publish an office rate for 19361 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 19361 covers
A surgeon, commonly a plastic surgeon, reconstructs the breast by moving latissimus dorsi tissue from the back to the chest while maintaining its blood supply. The flap may include overlying skin, depending on the reconstructive plan. This approach is used for breast reconstruction, often after mastectomy, and is generally performed in a hospital or other facility setting.
Report 19361 when the operative work reconstructs the breast with a latissimus dorsi flap; document the indication, recipient site, flap source, and operative technique. CMS assigns major-surgery status, so the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires 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.
Where 19361 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,349.68 |
| Metropolitan St. Louis, MO | Unavailable | $1,359.47 |
| Rest of Missouri | Unavailable | $1,312.44 |
How the 19361 rate is calculated
Each of 19361’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 · 19361
RVUs × geographic indexes × conversion factor
Work22.78
22.78 RVUs× 1.000 GPCI
Practice expense14.31
14.31 RVUs× 1.000 GPCI
Malpractice4.29
4.29 RVUs× 1.000 GPCI
Adjusted RVUs
41.3800
Conversion factor
$33.4009
Medicare rate
$1,382.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19361
19361 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19361
Breast reconstruction, latissimus dorsi flap
| 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 · 19361
Breast reconstruction, latissimus dorsi flap
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
19361 without 50 · national facility
$1,382.13
Breast reconstruction, latissimus dorsi flap
19361-50 · Bilateral: 150%
$2,073.20
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).
19361 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19364Free-flap reconstructionAutologous free tissue
- Choose 19361 for a latissimus flap transferred with its blood supply maintained. Code 19364 describes reconstruction with a free flap requiring transfer as free tissue.
- 19367Breast reconstructionSingle-pedicle TRAM flap
- Code 19367 describes reconstruction with a pedicled TRAM flap from the abdomen. Code 19361 uses latissimus dorsi tissue from the back.
- 19357Breast reconstructionTissue expander placement
- Code 19357 is for tissue-expander placement, not reconstruction with a latissimus dorsi flap.
19361 billing questions
How is 19361 different from a free-flap reconstruction?
19361 describes a latissimus dorsi flap moved to the chest with its blood supply maintained. A free flap is detached and transferred using microsurgical reconnection of its blood vessels.
Can 19361 be reported for both breasts?
For bilateral work, CMS identifies modifier 50 and pays the procedure at 150%. The operative report should establish that reconstruction was performed on both sides.
Does the 90-day global include postoperative visits?
Yes. The major-surgery global includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires 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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