CPT code 19367: Breast reconstruction, single-pedicle TRAM flap2026 Medicare rate & RVUs in Rhode Island

Reports breast reconstruction using an abdominal single-pedicle TRAM flap, typically after mastectomy, when the flap remains attached to its vascular supply.

CMS RVU26DEffective Oct 1, 2026One payment locality24 Medicare services in 2024

In Rhode Island, Medicare pays $1,575.55 for 19367 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)

$1,575.55Hospital or facility

Check a contract rate as a % of Medicare · 19367 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

Rate in Rhode Island
What 19367 covers
Compared with other areas
Rate map
How it’s calculated
Payment rules
Related codes
Rate history
Where it applies
Billing questions
Sources

What 19367 covers

The surgeon uses skin, fat, and a portion of rectus abdominis muscle from the abdomen to form a breast mound. The flap is tunneled to the chest while remaining connected to its original blood supply; this distinguishes the service from a free flap requiring microvascular reconnection. Plastic surgeons commonly perform this reconstruction after mastectomy in a hospital or other facility setting. The abdominal donor site is also closed as part of the reconstructive operation.

Select this code for the single-pedicle TRAM approach without microvascular anastomosis; a single-pedicle flap with microvascular anastomosis and a two-pedicle flap have separate codes. Document the flap technique, laterality, and reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; 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.

How Rhode Island compares for 19367

Across 109 of 109 payment localities, the facility rate for 19367 runs from $1,406.65 in Arkansas to $1,956.89 in Alaska. Rhode Island pays $1,575.55. The RVUs are the same everywhere; the geographic indexes change the dollars.

19367 in Rhode Island vs other payment areas

Rhode Island · this page$1,575.55
Los Angeles, CA · California$1,636.47+$60.92
Washington, DC area · District of Columbia$1,717.93+$142.38
Miami, FL · Florida$1,828.34+$252.79
Chicago, IL · Illinois$1,777.67+$202.12
Manhattan, NY · New York$1,794.89+$219.34
Alaska · Alaska$1,956.89+$381.34

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

Every other payment area

19367 in every other Medicare payment locality
Payment locality	Office	Facility
AlabamaAlabama	—	$1,423.30
ArkansasArkansas	—	$1,406.65
ArizonaArizona	—	$1,519.57
Bakersfield, CACalifornia	—	$1,562.74
Chico, CACalifornia	—	$1,549.17
El Centro, CACalifornia	—	$1,549.98
Fresno, CACalifornia	—	$1,549.17
Hanford, CACalifornia	—	$1,549.17
Madera, CACalifornia	—	$1,549.17
Merced, CACalifornia	—	$1,549.17
Modesto, CACalifornia	—	$1,549.17
Napa, CACalifornia	—	$1,701.19
Oxnard, CACalifornia	—	$1,617.96
Redding, CACalifornia	—	$1,549.17
Rest of CaliforniaCalifornia	—	$1,549.17
Riverside, CACalifornia	—	$1,601.39
Sacramento, CACalifornia	—	$1,600.88
Salinas, CACalifornia	—	$1,594.42
San Diego, CACalifornia	—	$1,613.92
Marin County, CACalifornia	—	$1,769.43
San Francisco, CACalifornia	—	$1,763.92
San Benito County, CACalifornia	—	$1,811.78
Santa Clara County, CACalifornia	—	$1,789.26
San Luis Obispo, CACalifornia	—	$1,571.72
Santa Cruz, CACalifornia	—	$1,615.06
Santa Maria, CACalifornia	—	$1,595.48
Santa Rosa, CACalifornia	—	$1,629.73
Stockton, CACalifornia	—	$1,549.17
Vallejo, CACalifornia	—	$1,693.26
Visalia, CACalifornia	—	$1,549.17
Yuba City, CACalifornia	—	$1,549.17
ColoradoColorado	—	$1,567.71
ConnecticutConnecticut	—	$1,651.01
DelawareDelaware	—	$1,540.86
Fort Lauderdale, FLFlorida	—	$1,696.86
Rest of FloridaFlorida	—	$1,617.56
Atlanta, GAGeorgia	—	$1,602.72
Rest of GeorgiaGeorgia	—	$1,533.62
Hawaii, Guam, HIHawaii	—	$1,562.80
IowaIowa	—	$1,416.90
IdahoIdaho	—	$1,431.83
East St. Louis, ILIllinois	—	$1,681.46
Rest of IllinoisIllinois	—	$1,604.73
Suburban Chicago, ILIllinois	—	$1,704.48
IndianaIndiana	—	$1,437.61
KansasKansas	—	$1,428.46
KentuckyKentucky	—	$1,487.18
New Orleans, LALouisiana	—	$1,550.25
Rest of LouisianaLouisiana	—	$1,492.04
Metropolitan Boston, MAMassachusetts	—	$1,678.85
Rest of MassachusettsMassachusetts	—	$1,568.03
Baltimore area, MDMaryland	—	$1,649.79
Rest of MarylandMaryland	—	$1,560.89
Rest of MaineMaine	—	$1,455.97
Southern Maine, MEMaine	—	$1,494.66
Detroit, MIMichigan	—	$1,651.93
Rest of MichiganMichigan	—	$1,534.43
MinnesotaMinnesota	—	$1,460.32
Metropolitan Kansas City, MOMissouri	—	$1,523.44
Metropolitan St. Louis, MOMissouri	—	$1,534.31
Rest of MissouriMissouri	—	$1,482.58
MississippiMississippi	—	$1,443.98
MontanaMontana	—	$1,558.83
North CarolinaNorth Carolina	—	$1,465.54
North DakotaNorth Dakota	—	$1,462.93
NebraskaNebraska	—	$1,418.02
New HampshireNew Hampshire	—	$1,560.40
Northern New JerseyNew Jersey	—	$1,709.06
Rest of New JerseyNew Jersey	—	$1,658.02
New MexicoNew Mexico	—	$1,548.19
NevadaNevada	—	$1,532.63
NYC suburbs and Long Island, NYNew York	—	$1,852.95
Poughkeepsie and northern NYC suburbs, NYNew York	—	$1,682.26
Queens, NYNew York	—	$1,782.05
Rest of New YorkNew York	—	$1,484.82
OhioOhio	—	$1,514.83
OklahomaOklahoma	—	$1,466.92
Portland, OROregon	—	$1,589.86
Rest of OregonOregon	—	$1,508.94
Metropolitan Philadelphia, PAPennsylvania	—	$1,627.63
Rest of PennsylvaniaPennsylvania	—	$1,507.24
Puerto RicoPuerto Rico	—	$1,562.49
South CarolinaSouth Carolina	—	$1,495.00
South DakotaSouth Dakota	—	$1,451.59
TennesseeTennessee	—	$1,436.43
Austin, TXTexas	—	$1,572.85
Beaumont, TXTexas	—	$1,500.46
Brazoria, TXTexas	—	$1,525.78
Dallas, TXTexas	—	$1,541.91
Fort Worth, TXTexas	—	$1,538.77
Galveston, TXTexas	—	$1,534.60
Houston, TXTexas	—	$1,623.38
Rest of TexasTexas	—	$1,516.70
UtahUtah	—	$1,511.17
VirginiaVirginia	—	$1,502.61
Virgin Islands, VIUnited States Virgin Islands	—	$1,562.49
VermontVermont	—	$1,473.88
Rest of WashingtonWashington	—	$1,559.58
King County, WAWashington	—	$1,692.18
WisconsinWisconsin	—	$1,425.03
West VirginiaWest Virginia	—	$1,560.28
WyomingWyoming	—	$1,517.04

19367 rates by state

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

ME WI VT NH MT ND MN MI NY MA RI WA ID WY SD IA IL IN OH PA NJ CT OR NV UT CO NE MO KY WV VA MD DE CA AZ NM KS OK AR TN NC SC DC TX LA MS AL GA FL AK HI

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19367 office rate range by state
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

See 19367 in every payment locality

How the 19367 rate is calculated

Each of 19367’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 · 19367

RVUs × geographic indexes × conversion factor

Office or facility?

Your ZIP

Work26.13

26.13 RVUs× 1.000 GPCI

Practice expense15.70

15.70 RVUs× 1.000 GPCI

Malpractice4.85

4.85 RVUs× 1.000 GPCI

Adjusted RVUs

46.6800

Conversion factor

$33.4009

Medicare rate

$1,559.15

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

The exact Rhode Island inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,704

Code: 19367
Physician work: 26.13
Practice expense: 15.70
Malpractice: 4.85

GPCI2026.csv

Locality: Rhode Island
Physician work: 1.019
Practice expense: 1.033
Malpractice: 0.892

Facility calculation for 19367 in Rhode Island
Component	RVU	Locality factor	Adjusted
Physician work	26.13	× 1.019	26.6265
Practice expense	15.70	× 1.033	16.2181
Malpractice	4.85	× 0.892	4.3262
Total RVUs			47.1708
Conversion factor			× 33.4009

Facility rate, Rhode Island$1575.55

Facility: (26.13 × 1.019 + 15.7 × 1.033 + 4.85 × 0.892) × $33.4009 = $1575.55

Open 19367 in the RVU calculator

Payment rules and modifiers for 19367

19367 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19367

Breast reconstruction, single-pedicle TRAM 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 · 19367

Breast reconstruction, single-pedicle TRAM flap

Date of surgery

Date of a later visit

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

19367 without 50 · national facility

$1,559.15

Breast reconstruction, single-pedicle TRAM flap

19367-50 · Bilateral: 150%

$2,338.73

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 19367

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

Codes related to 19367
Code	How it relates	Office range, Rhode Island
Same family
19368	TRAM reconstruction, single pedicle, microvascularSingle-pedicle TRAM reconstruction with microvascular anastomosis.	No office rate
19369	TRAM flap reconstruction, two-pedicle techniqueTRAM reconstruction using two pedicles.	No office rate
Used instead
19364	Free-flap reconstruction, autologous free tissueBreast reconstruction using a free flap rather than a pedicled TRAM flap.	No office rate
19361	Breast reconstruction, latissimus dorsi flapUses a latissimus dorsi flap instead of abdominal TRAM tissue.	No office rate
19357	Breast reconstruction, tissue expander placementUses tissue-expander placement for reconstruction rather than a TRAM flap.	No office rate
Often billed with
19303	Mastectomy, complete, without axillary dissectionMay be reported for a complete mastectomy performed in the same session.	No office rate

How 19367 has changed in Rhode Island

19367 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

Compare with release effective

A rate is unavailable in one of these releases, so a change cannot be calculated.

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

Rates in every CMS release
Effective from	Office	Facility	CMS release
2026-10-01	Not available in this setting	$1,575.55	RVU26D
2026-07-01	Not available in this setting	$1,575.55	RVU26C
2026-04-01	Not available in this setting	$1,575.55	RVU26B
2026-01-01	Not available in this setting	$1,575.55	RVU26A
2025-10-01	Not available in this setting	$1,755.04	RVU25D
2025-07-01	Not available in this setting	$1,755.04	RVU25C
2025-04-01	Not available in this setting	$1,755.04	RVU25B
2025-01-01	Not available in this setting	$1,755.04	RVU25A
2024-10-01	Not available in this setting	$1,788.90	RVU24D
2024-07-01	Not available in this setting	$1,788.90	RVU24C
2024-04-01	Not available in this setting	$1,788.90	RVU24B
2024-03-09	Not available in this setting	$1,788.90	RVU24AR
2024-01-01	Not available in this setting	$1,759.70	RVU24A
2023-10-01	Not available in this setting	$1,829.95	RVU23D
2023-07-01	Not available in this setting	$1,829.95	RVU23C
2023-04-01	Not available in this setting	$1,829.95	RVU23B
2023-01-01	Not available in this setting	$1,829.95	RVU23A
2022-10-01	Not available in this setting	$1,861.80	RVU22D
2022-07-01	Not available in this setting	$1,861.80	RVU22C
2022-04-01	Not available in this setting	$1,861.80	RVU22B
2022-01-01	Not available in this setting	$1,861.80	RVU22A
2021-10-01	Not available in this setting	$1,866.82	RVU21D
2021-07-01	Not available in this setting	$1,866.82	RVU21C
2021-04-01	Not available in this setting	$1,866.82	RVU21B
2021-01-01	Not available in this setting	$1,866.82	RVU21A
2020-10-01	Not available in this setting	$1,915.31	RVU20D
2020-07-01	Not available in this setting	$1,915.31	RVU20C
2020-04-01	Not available in this setting	$1,915.31	RVU20B
2020-01-01	Not available in this setting	$1,915.31	RVU20A
2019-10-01	Not available in this setting	$1,912.13	RVU19D
2019-07-01	Not available in this setting	$1,912.13	RVU19C
2019-04-01	Not available in this setting	$1,912.13	RVU19B
2019-01-01	Not available in this setting	$1,912.13	RVU19A
2018-10-01	Not available in this setting	$1,920.02	RVU18D
2018-07-01	Not available in this setting	$1,920.02	RVU18C
2018-04-01	Not available in this setting	$1,920.02	RVU18B
2018-01-01	Not available in this setting	$1,920.02	RVU18AR1
2017-10-01	Not available in this setting	$1,890.98	RVU17D
2017-07-01	Not available in this setting	$1,890.98	RVU17C
2017-04-01	Not available in this setting	$1,890.98	RVU17B
2017-01-01	Not available in this setting	$1,890.98	RVU17A
2016-10-01	Not available in this setting	$1,861.43	RVU16D
2016-07-01	Not available in this setting	$1,861.43	RVU16C
2016-04-01	Not available in this setting	$1,861.43	RVU16B
2016-01-01	Not available in this setting	$1,861.43	RVU16A
2015-10-01	Not available in this setting	$1,868.01	RVU15D
2015-07-01	Not available in this setting	$1,868.01	RVU15C
2015-04-01	Not available in this setting	$1,858.71	RVU15B
2015-01-01	Not available in this setting	$1,858.71	RVU15A
2014-10-01	Not available in this setting	$1,911.24	RVU14D
2014-07-01	Not available in this setting	$1,911.24	RVU14C
2014-04-01	Not available in this setting	$1,911.24	RVU14B
2014-01-01	Not available in this setting	$1,911.24	RVU14A
2013-10-01	Not available in this setting	Rate data unavailable	RVU13D
2013-07-01	Not available in this setting	Rate data unavailable	RVU13C
2013-04-01	Not available in this setting	Rate data unavailable	RVU13B
2013-01-01	Not available in this setting	Rate data unavailable	RVU13AR

Price 19367 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

Ashaway
Bradford
Carolina
Central Falls
Charlestown
Chepachet
Clayville
Cranston

Browse all communities in Rhode Island

19367 billing questions

How is 19367 distinguished from 19368?

19367 describes a single-pedicle TRAM flap that remains connected to its blood supply. Use 19368 when the single-pedicle flap involves microvascular anastomosis.

When is 19369 used instead?

19369 is for breast reconstruction using a two-pedicle TRAM flap. The number of pedicles used, rather than the size of the reconstruction, distinguishes it from 19367.

Can the mastectomy be reported in the same session?

The mastectomy and the TRAM-flap reconstruction are distinct services and may be reported for the same session when both are performed. For same-session procedures, CMS applies the standard multiple procedure reduction.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. The operative record should identify the flap method and laterality.

How is bilateral reconstruction handled?

CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%. Document the reconstruction performed on each side.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be allowed. 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

RVUs for 19367PPRRVU2026_Oct_nonQPP.csv, line 1,704 (RVU26D)

1,70119357,,[CPT descriptor omitted],A,,14.47,14.93,NA,14.93,,2.72,32.12,32.12,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70219361,,[CPT descriptor omitted],A,,22.78,14.31,NA,14.31,,4.29,41.38,41.38,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70319364,,[CPT descriptor omitted],A,,41.52,21.49,NA,21.49,,7.93,70.94,70.94,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70419367,,[CPT descriptor omitted],A,,26.13,15.70,NA,15.70,,4.85,46.68,46.68,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70519368,,[CPT descriptor omitted],A,,33.05,17.28,NA,17.28,,6.15,56.48,56.48,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70619369,,[CPT descriptor omitted],A,,30.53,16.36,NA,16.36,,5.68,52.57,52.57,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,70719370,,[CPT descriptor omitted],A,,8.94,7.82,NA,7.82,,1.68,18.44,18.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

Geographic factors for Rhode IslandGPCI2026.csv, line 92 (RVU26D)

8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193

9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945

9109202,PR,20,PUERTO RICO,1.000,1.011,0.985

9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892

9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850

9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336

9510312,TN,35,TENNESSEE,1.000,0.909,0.537

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What 19367 covers

How Rhode Island compares for 19367

Every other payment area

19367 rates by state

How the 19367 rate is calculated

Payment rules and modifiers for 19367

What modifiers do to the payment

Codes related to 19367

How 19367 has changed in Rhode Island

Where the Rhode Island rate applies

19367 billing questions

How is 19367 distinguished from 19368?

When is 19369 used instead?

Can the mastectomy be reported in the same session?

What postoperative care is included?

How is bilateral reconstruction handled?

Can an assistant or co-surgeon be reported?

Where these rates come from

Did this answer your question about what 19367 pays in Rhode Island?

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