CPT code 19368: TRAM reconstruction, single pedicle, microvascular2026 Medicare rate & RVUs in South Carolina
Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy.
In South Carolina, Medicare pays $1,811.81 for 19368 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 19368 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 19368 covers
This service reconstructs a breast with tissue from the lower abdomen that includes skin, fat, and rectus abdominis muscle. The surgeon transfers the single-pedicle TRAM flap and performs microvascular anastomosis to establish its blood supply at the recipient site. Plastic and reconstructive surgeons typically perform the procedure in a hospital operating room, often as reconstruction following mastectomy. The flap transfer and its microvascular anastomosis are central to distinguishing this service from a TRAM flap that remains attached to its native pedicle.
Report the code when the operative record supports a single-pedicle TRAM reconstruction with microvascular anastomosis. Documentation should identify the flap and pedicle, the transfer and anastomosis performed, and the reconstructed side or sides. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple procedures, 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 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.
How South Carolina compares for 19368
Across 109 of 109 payment localities, the facility rate for 19368 runs from $1,705.48 in Arkansas to $2,383.72 in Alaska. South Carolina pays $1,811.81. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Carolina · this page$1,811.81
- Los Angeles, CA · California$1,968.34+$156.53
- Washington, DC area · District of Columbia$2,072.04+$260.23
- Miami, FL · Florida$2,224.23+$412.42
- Chicago, IL · Illinois$2,163.11+$351.30
- Manhattan, NY · New York$2,171.01+$359.20
- Alaska · Alaska$2,383.72+$571.91
Other areas in South Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $1,725.19 |
| ArkansasArkansas | — | $1,705.48 |
| ArizonaArizona | — | $1,839.01 |
| Bakersfield, CACalifornia | — | $1,882.55 |
| Chico, CACalifornia | — | $1,865.34 |
| El Centro, CACalifornia | — | $1,866.37 |
| Fresno, CACalifornia | — | $1,865.34 |
| Hanford, CACalifornia | — | $1,865.34 |
| Madera, CACalifornia | — | $1,865.34 |
| Merced, CACalifornia | — | $1,865.34 |
| Modesto, CACalifornia | — | $1,865.34 |
| Napa, CACalifornia | — | $2,038.50 |
| Oxnard, CACalifornia | — | $1,944.99 |
| Redding, CACalifornia | — | $1,865.34 |
| Rest of CaliforniaCalifornia | — | $1,865.34 |
| Riverside, CACalifornia | — | $1,931.57 |
| Sacramento, CACalifornia | — | $1,924.99 |
| Salinas, CACalifornia | — | $1,917.16 |
| San Diego, CACalifornia | — | $1,938.64 |
| Marin County, CACalifornia | — | $2,116.86 |
| San Francisco, CACalifornia | — | $2,109.88 |
| San Benito County, CACalifornia | — | $2,167.71 |
| Santa Clara County, CACalifornia | — | $2,139.15 |
| San Luis Obispo, CACalifornia | — | $1,890.16 |
| Santa Cruz, CACalifornia | — | $1,938.44 |
| Santa Maria, CACalifornia | — | $1,917.89 |
| Santa Rosa, CACalifornia | — | $1,955.88 |
| Stockton, CACalifornia | — | $1,865.34 |
| Vallejo, CACalifornia | — | $2,028.44 |
| Visalia, CACalifornia | — | $1,865.34 |
| Yuba City, CACalifornia | — | $1,865.34 |
| ColoradoColorado | — | $1,891.68 |
| ConnecticutConnecticut | — | $1,996.14 |
| DelawareDelaware | — | $1,864.33 |
| Fort Lauderdale, FLFlorida | — | $2,059.96 |
| Rest of FloridaFlorida | — | $1,964.41 |
| Atlanta, GAGeorgia | — | $1,940.32 |
| Rest of GeorgiaGeorgia | — | $1,863.59 |
| Hawaii, Guam, HIHawaii | — | $1,879.07 |
| IowaIowa | — | $1,713.56 |
| IdahoIdaho | — | $1,732.06 |
| East St. Louis, ILIllinois | — | $2,048.60 |
| Rest of IllinoisIllinois | — | $1,951.92 |
| Suburban Chicago, ILIllinois | — | $2,068.37 |
| IndianaIndiana | — | $1,738.77 |
| KansasKansas | — | $1,729.19 |
| KentuckyKentucky | — | $1,804.96 |
| New Orleans, LALouisiana | — | $1,880.37 |
| Rest of LouisianaLouisiana | — | $1,811.48 |
| Metropolitan Boston, MAMassachusetts | — | $2,021.12 |
| Rest of MassachusettsMassachusetts | — | $1,893.04 |
| Baltimore area, MDMaryland | — | $1,994.96 |
| Rest of MarylandMaryland | — | $1,887.60 |
| Rest of MaineMaine | — | $1,762.66 |
| Southern Maine, MEMaine | — | $1,805.49 |
| Detroit, MIMichigan | — | $2,007.20 |
| Rest of MichiganMichigan | — | $1,862.77 |
| MinnesotaMinnesota | — | $1,758.61 |
| Metropolitan Kansas City, MOMissouri | — | $1,846.55 |
| Metropolitan St. Louis, MOMissouri | — | $1,859.19 |
| Rest of MissouriMissouri | — | $1,801.49 |
| MississippiMississippi | — | $1,752.64 |
| MontanaMontana | — | $1,886.07 |
| North CarolinaNorth Carolina | — | $1,773.66 |
| North DakotaNorth Dakota | — | $1,764.47 |
| NebraskaNebraska | — | $1,714.27 |
| New HampshireNew Hampshire | — | $1,884.47 |
| Northern New JerseyNew Jersey | — | $2,062.34 |
| Rest of New JerseyNew Jersey | — | $2,003.66 |
| New MexicoNew Mexico | — | $1,879.87 |
| NevadaNevada | — | $1,852.76 |
| NYC suburbs and Long Island, NYNew York | — | $2,242.26 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $2,034.13 |
| Queens, NYNew York | — | $2,152.97 |
| Rest of New YorkNew York | — | $1,796.62 |
| OhioOhio | — | $1,837.91 |
| OklahomaOklahoma | — | $1,778.92 |
| Portland, OROregon | — | $1,915.62 |
| Rest of OregonOregon | — | $1,823.17 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,969.66 |
| Rest of PennsylvaniaPennsylvania | — | $1,827.86 |
| Puerto RicoPuerto Rico | — | $1,889.75 |
| Rhode IslandRhode Island | — | $1,904.32 |
| South DakotaSouth Dakota | — | $1,750.09 |
| TennesseeTennessee | — | $1,738.85 |
| Austin, TXTexas | — | $1,898.75 |
| Beaumont, TXTexas | — | $1,819.95 |
| Brazoria, TXTexas | — | $1,844.93 |
| Dallas, TXTexas | — | $1,864.94 |
| Fort Worth, TXTexas | — | $1,861.84 |
| Galveston, TXTexas | — | $1,855.94 |
| Houston, TXTexas | — | $1,968.51 |
| Rest of TexasTexas | — | $1,837.12 |
| UtahUtah | — | $1,830.90 |
| VirginiaVirginia | — | $1,816.28 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,889.75 |
| VermontVermont | — | $1,779.24 |
| Rest of WashingtonWashington | — | $1,882.33 |
| King County, WAWashington | — | $2,035.10 |
| WisconsinWisconsin | — | $1,720.09 |
| West VirginiaWest Virginia | — | $1,899.41 |
| WyomingWyoming | — | $1,833.07 |
19368 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 19368 rate is calculated
Each of 19368’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 · 19368
RVUs × geographic indexes × conversion factor
Work33.05
33.05 RVUs× 1.000 GPCI
Practice expense17.28
17.28 RVUs× 1.000 GPCI
Malpractice6.15
6.15 RVUs× 1.000 GPCI
Adjusted RVUs
56.4800
Conversion factor
$33.4009
Medicare rate
$1,886.48
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact South Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,705
- Code
- 19368
- Physician work
- 33.05
- Practice expense
- 17.28
- Malpractice
- 6.15
GPCI2026.csv
93
- Locality
- South Carolina
- Physician work
- 1.000
- Practice expense
- 0.924
- Malpractice
- 0.850
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 33.05 | × 1.000 | 33.0500 |
| Practice expense | 17.28 | × 0.924 | 15.9667 |
| Malpractice | 6.15 | × 0.850 | 5.2275 |
| Total RVUs | 54.2442 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, South Carolina$1811.81
Facility: (33.05 × 1 + 17.28 × 0.924 + 6.15 × 0.85) × $33.4009 = $1811.81
Payment rules and modifiers for 19368
19368 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19368
TRAM reconstruction, single pedicle, microvascular
| 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 · 19368
TRAM reconstruction, single pedicle, microvascular
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
19368 without 50 · national facility
$1,886.48
TRAM reconstruction, single pedicle, microvascular
19368-50 · Bilateral: 150%
$2,829.72
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 19368 has changed in South Carolina
19368 · 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 | $1,811.81 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,811.81 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,811.81 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,811.81 | RVU26A |
| 2025-10-01 | Not available in this setting | $2,005.79 | RVU25D |
| 2025-07-01 | Not available in this setting | $2,005.79 | RVU25C |
| 2025-04-01 | Not available in this setting | $2,005.79 | RVU25B |
| 2025-01-01 | Not available in this setting | $2,005.79 | RVU25A |
| 2024-10-01 | Not available in this setting | $2,047.81 | RVU24D |
| 2024-07-01 | Not available in this setting | $2,047.81 | RVU24C |
| 2024-04-01 | Not available in this setting | $2,047.81 | RVU24B |
| 2024-03-09 | Not available in this setting | $2,047.81 | RVU24AR |
| 2024-01-01 | Not available in this setting | $2,014.39 | RVU24A |
| 2023-10-01 | Not available in this setting | $2,066.29 | RVU23D |
| 2023-07-01 | Not available in this setting | $2,066.29 | RVU23C |
| 2023-04-01 | Not available in this setting | $2,066.29 | RVU23B |
| 2023-01-01 | Not available in this setting | $2,066.29 | RVU23A |
| 2022-10-01 | Not available in this setting | $2,075.62 | RVU22D |
| 2022-07-01 | Not available in this setting | $2,075.62 | RVU22C |
| 2022-04-01 | Not available in this setting | $2,075.62 | RVU22B |
| 2022-01-01 | Not available in this setting | $2,075.62 | RVU22A |
| 2021-10-01 | Not available in this setting | $2,086.47 | RVU21D |
| 2021-07-01 | Not available in this setting | $2,086.47 | RVU21C |
| 2021-04-01 | Not available in this setting | $2,086.47 | RVU21B |
| 2021-01-01 | Not available in this setting | $2,086.47 | RVU21A |
| 2020-10-01 | Not available in this setting | $2,132.88 | RVU20D |
| 2020-07-01 | Not available in this setting | $2,132.88 | RVU20C |
| 2020-04-01 | Not available in this setting | $2,132.88 | RVU20B |
| 2020-01-01 | Not available in this setting | $2,132.88 | RVU20A |
| 2019-10-01 | Not available in this setting | $2,110.88 | RVU19D |
| 2019-07-01 | Not available in this setting | $2,110.88 | RVU19C |
| 2019-04-01 | Not available in this setting | $2,110.88 | RVU19B |
| 2019-01-01 | Not available in this setting | $2,110.88 | RVU19A |
| 2018-10-01 | Not available in this setting | $2,114.14 | RVU18D |
| 2018-07-01 | Not available in this setting | $2,114.14 | RVU18C |
| 2018-04-01 | Not available in this setting | $2,114.14 | RVU18B |
| 2018-01-01 | Not available in this setting | $2,114.14 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $2,128.08 | RVU17D |
| 2017-07-01 | Not available in this setting | $2,128.08 | RVU17C |
| 2017-04-01 | Not available in this setting | $2,128.08 | RVU17B |
| 2017-01-01 | Not available in this setting | $2,128.08 | RVU17A |
| 2016-10-01 | Not available in this setting | $2,133.27 | RVU16D |
| 2016-07-01 | Not available in this setting | $2,133.27 | RVU16C |
| 2016-04-01 | Not available in this setting | $2,133.27 | RVU16B |
| 2016-01-01 | Not available in this setting | $2,133.27 | RVU16A |
| 2015-10-01 | Not available in this setting | $2,138.72 | RVU15D |
| 2015-07-01 | Not available in this setting | $2,138.72 | RVU15C |
| 2015-04-01 | Not available in this setting | $2,128.08 | RVU15B |
| 2015-01-01 | Not available in this setting | $2,128.08 | RVU15A |
| 2014-10-01 | Not available in this setting | $2,125.16 | RVU14D |
| 2014-07-01 | Not available in this setting | $2,125.16 | RVU14C |
| 2014-04-01 | Not available in this setting | $2,125.16 | RVU14B |
| 2014-01-01 | Not available in this setting | $2,125.16 | RVU14A |
| 2013-10-01 | Not available in this setting | $2,058.17 | RVU13D |
| 2013-07-01 | Not available in this setting | $2,058.17 | RVU13C |
| 2013-04-01 | Not available in this setting | $2,058.17 | RVU13B |
| 2013-01-01 | Not available in this setting | $2,058.17 | RVU13AR |
Where the South Carolina rate applies
South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.
- Abbeville
- Abney Crossroads
- Adams Run
- Aiken
- Alcolu
- Allendale
- Anderson
- Andrews
19368 billing questions
How does 19368 differ from 19367?
19368 describes a single-pedicle TRAM flap with microvascular anastomosis. 19367 is the single-pedicle TRAM flap service without that anastomosis distinction.
Is the microvascular anastomosis included?
Yes. It is part of the 19368 service, so the anastomosis used to transfer the TRAM flap is not a separate service under this code.
When would 19364 be considered instead?
19364 is used for breast reconstruction with a free flap other than the specifically described single-pedicle TRAM flap with microvascular anastomosis.
How is bilateral reconstruction handled?
CMS identifies this as a bilateral procedure: modifier 50 is paid at 150%. Document the reconstruction performed on each side.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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