CPT code 19369: TRAM flap reconstruction, two-pedicle technique2026 Medicare rate & RVUs in Santa Maria, CA
Reports breast reconstruction using a pedicled abdominal TRAM flap supplied by two pedicles, typically after mastectomy when autologous tissue is selected.
In Santa Maria, CA, Medicare pays $1,787.12 for 19369 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 19369 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 19369 covers
A surgeon transfers lower abdominal skin, fat, and associated rectus muscle to create a breast mound, maintaining blood supply through two pedicles. Plastic surgeons commonly perform this reconstruction after mastectomy, either during the mastectomy operation or as a later procedure. The operative report should identify the abdominal tissue transferred and document the two-pedicle technique; this is distinct from a free flap transferred with microvascular reconnection.
Select this code for the two-pedicle TRAM approach, rather than a one-pedicle TRAM or another flap method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%. An assistant at surgery may be paid; 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 Santa Maria, CA compares for 19369
Across 109 of 109 payment localities, the facility rate for 19369 runs from $1,586.82 in Arkansas to $2,216.09 in Alaska. Santa Maria, CA pays $1,787.12. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Santa Maria, CA · this page$1,787.12
- Bakersfield, CA · California$1,753.54−$33.58
- Chico, CA · California$1,737.65−$49.47
- El Centro, CA · California$1,738.60−$48.52
- Fresno, CA · California$1,737.65−$49.47
- Hanford, CA · California$1,737.65−$49.47
- Los Angeles, CA · California$1,833.95+$46.83
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | — | $1,737.65 |
| Merced, CACalifornia | — | $1,737.65 |
| Modesto, CACalifornia | — | $1,737.65 |
| Napa, CACalifornia | — | $1,900.55 |
| Oxnard, CACalifornia | — | $1,812.37 |
| Redding, CACalifornia | — | $1,737.65 |
| Rest of CaliforniaCalifornia | — | $1,737.65 |
| Riverside, CACalifornia | — | $1,798.81 |
| Sacramento, CACalifornia | — | $1,793.64 |
| Salinas, CACalifornia | — | $1,786.35 |
| San Diego, CACalifornia | — | $1,806.69 |
| Marin County, CACalifornia | — | $1,974.16 |
| San Francisco, CACalifornia | — | $1,967.71 |
| San Benito County, CACalifornia | — | $2,021.55 |
| Santa Clara County, CACalifornia | — | $1,995.18 |
| San Luis Obispo, CACalifornia | — | $1,761.15 |
| Santa Cruz, CACalifornia | — | $1,806.76 |
| Santa Rosa, CACalifornia | — | $1,823.04 |
| Stockton, CACalifornia | — | $1,737.65 |
| Vallejo, CACalifornia | — | $1,891.26 |
| Visalia, CACalifornia | — | $1,737.65 |
| Yuba City, CACalifornia | — | $1,737.65 |
| Washington, DC areaDistrict of Columbia | — | $1,929.65 |
| Miami, FLFlorida | — | $2,068.37 |
| Chicago, ILIllinois | — | $2,011.44 |
| Manhattan, NYNew York | — | $2,020.85 |
| AlaskaAlaska | — | $2,216.09 |
| AlabamaAlabama | — | $1,605.24 |
| ArkansasArkansas | — | $1,586.82 |
| ArizonaArizona | — | $1,711.63 |
| ColoradoColorado | — | $1,761.55 |
| ConnecticutConnecticut | — | $1,858.20 |
| DelawareDelaware | — | $1,735.27 |
| Fort Lauderdale, FLFlorida | — | $1,916.28 |
| Rest of FloridaFlorida | — | $1,827.27 |
| Atlanta, GAGeorgia | — | $1,805.82 |
| Rest of GeorgiaGeorgia | — | $1,733.30 |
| Hawaii, Guam, HIHawaii | — | $1,750.88 |
| IowaIowa | — | $1,595.04 |
| IdahoIdaho | — | $1,612.19 |
| East St. Louis, ILIllinois | — | $1,904.54 |
| Rest of IllinoisIllinois | — | $1,815.16 |
| Suburban Chicago, ILIllinois | — | $1,924.24 |
| IndianaIndiana | — | $1,618.48 |
| KansasKansas | — | $1,609.33 |
| KentuckyKentucky | — | $1,679.10 |
| New Orleans, LALouisiana | — | $1,749.45 |
| Rest of LouisianaLouisiana | — | $1,685.08 |
| Metropolitan Boston, MAMassachusetts | — | $1,882.83 |
| Rest of MassachusettsMassachusetts | — | $1,762.65 |
| Baltimore area, MDMaryland | — | $1,857.05 |
| Rest of MarylandMaryland | — | $1,757.08 |
| Rest of MaineMaine | — | $1,640.46 |
| Southern Maine, MEMaine | — | $1,680.96 |
| Detroit, MIMichigan | — | $1,866.91 |
| Rest of MichiganMichigan | — | $1,732.82 |
| MinnesotaMinnesota | — | $1,638.17 |
| Metropolitan Kansas City, MOMissouri | — | $1,718.19 |
| Metropolitan St. Louis, MOMissouri | — | $1,730.04 |
| Rest of MissouriMissouri | — | $1,675.54 |
| MississippiMississippi | — | $1,630.41 |
| MontanaMontana | — | $1,755.51 |
| North CarolinaNorth Carolina | — | $1,650.79 |
| North DakotaNorth Dakota | — | $1,643.19 |
| NebraskaNebraska | — | $1,595.81 |
| New HampshireNew Hampshire | — | $1,754.57 |
| Northern New JerseyNew Jersey | — | $1,920.46 |
| Rest of New JerseyNew Jersey | — | $1,865.35 |
| New MexicoNew Mexico | — | $1,748.66 |
| NevadaNevada | — | $1,724.75 |
| NYC suburbs and Long Island, NYNew York | — | $2,087.01 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,893.53 |
| Queens, NYNew York | — | $2,004.45 |
| Rest of New YorkNew York | — | $1,672.22 |
| OhioOhio | — | $1,709.86 |
| OklahomaOklahoma | — | $1,655.11 |
| Portland, OROregon | — | $1,784.29 |
| Rest of OregonOregon | — | $1,697.35 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,833.26 |
| Rest of PennsylvaniaPennsylvania | — | $1,700.64 |
| Puerto RicoPuerto Rico | — | $1,759.05 |
| Rhode IslandRhode Island | — | $1,772.80 |
| South CarolinaSouth Carolina | — | $1,685.90 |
| South DakotaSouth Dakota | — | $1,629.91 |
| TennesseeTennessee | — | $1,618.32 |
| Austin, TXTexas | — | $1,767.99 |
| Beaumont, TXTexas | — | $1,693.24 |
| Brazoria, TXTexas | — | $1,717.39 |
| Dallas, TXTexas | — | $1,735.94 |
| Fort Worth, TXTexas | — | $1,732.94 |
| Galveston, TXTexas | — | $1,727.59 |
| Houston, TXTexas | — | $1,831.55 |
| Rest of TexasTexas | — | $1,709.61 |
| UtahUtah | — | $1,703.75 |
| VirginiaVirginia | — | $1,690.82 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,759.05 |
| VermontVermont | — | $1,656.70 |
| Rest of WashingtonWashington | — | $1,752.76 |
| King County, WAWashington | — | $1,896.20 |
| WisconsinWisconsin | — | $1,601.65 |
| West VirginiaWest Virginia | — | $1,766.07 |
| WyomingWyoming | — | $1,706.56 |
19369 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 19369 rate is calculated
Each of 19369’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 · 19369
RVUs × geographic indexes × conversion factor
Work30.53
30.53 RVUs× 1.000 GPCI
Practice expense16.36
16.36 RVUs× 1.000 GPCI
Malpractice5.68
5.68 RVUs× 1.000 GPCI
Adjusted RVUs
52.5700
Conversion factor
$33.4009
Medicare rate
$1,755.89
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Santa Maria, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,706
- Code
- 19369
- Physician work
- 30.53
- Practice expense
- 16.36
- Malpractice
- 5.68
GPCI2026.csv
30
- Locality
- Santa Maria, CA
- Physician work
- 1.028
- Practice expense
- 1.166
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 30.53 | × 1.028 | 31.3848 |
| Practice expense | 16.36 | × 1.166 | 19.0758 |
| Malpractice | 5.68 | × 0.536 | 3.0445 |
| Total RVUs | 53.5051 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Santa Maria, CA$1787.12
Facility: (30.53 × 1.028 + 16.36 × 1.166 + 5.68 × 0.536) × $33.4009 = $1787.12
Payment rules and modifiers for 19369
19369 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19369
TRAM flap reconstruction, two-pedicle technique
| 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 · 19369
TRAM flap reconstruction, two-pedicle technique
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
19369 without 50 · national facility
$1,755.89
TRAM flap reconstruction, two-pedicle technique
19369-50 · Bilateral: 150%
$2,633.84
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 19369 has changed in Santa Maria, CA
19369 · 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 | $1,787.12 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,787.12 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,787.12 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,787.12 | RVU26A |
| 2025-10-01 | Not available in this setting | $2,038.85 | RVU25D |
| 2025-07-01 | Not available in this setting | $2,038.85 | RVU25C |
| 2025-04-01 | Not available in this setting | $2,038.85 | RVU25B |
| 2025-01-01 | Not available in this setting | $2,038.85 | RVU25A |
| 2024-10-01 | Not available in this setting | $2,077.77 | RVU24D |
| 2024-07-01 | Not available in this setting | $2,077.77 | RVU24C |
| 2024-04-01 | Not available in this setting | $2,077.77 | RVU24B |
| 2024-03-09 | Not available in this setting | $2,077.77 | RVU24AR |
| 2024-01-01 | Not available in this setting | $2,043.86 | RVU24A |
| 2023-10-01 | Not available in this setting | $2,128.72 | RVU23D |
| 2023-07-01 | Not available in this setting | $2,128.72 | RVU23C |
| 2023-04-01 | Not available in this setting | $2,128.72 | RVU23B |
| 2023-01-01 | Not available in this setting | $2,128.72 | RVU23A |
| 2022-10-01 | Not available in this setting | $2,165.91 | RVU22D |
| 2022-07-01 | Not available in this setting | $2,165.91 | RVU22C |
| 2022-04-01 | Not available in this setting | $2,165.91 | RVU22B |
| 2022-01-01 | Not available in this setting | $2,165.91 | RVU22A |
| 2021-10-01 | Not available in this setting | $2,160.41 | RVU21D |
| 2021-07-01 | Not available in this setting | $2,160.41 | RVU21C |
| 2021-04-01 | Not available in this setting | $2,160.41 | RVU21B |
| 2021-01-01 | Not available in this setting | $2,160.41 | RVU21A |
| 2020-10-01 | Not available in this setting | $2,197.59 | RVU20D |
| 2020-07-01 | Not available in this setting | $2,197.59 | RVU20C |
| 2020-04-01 | Not available in this setting | $2,197.59 | RVU20B |
| 2020-01-01 | Not available in this setting | $2,197.59 | RVU20A |
| 2019-10-01 | Not available in this setting | $2,167.03 | RVU19D |
| 2019-07-01 | Not available in this setting | $2,167.03 | RVU19C |
| 2019-04-01 | Not available in this setting | $2,167.03 | RVU19B |
| 2019-01-01 | Not available in this setting | $2,167.03 | RVU19A |
| 2018-10-01 | Not available in this setting | $2,151.83 | RVU18D |
| 2018-07-01 | Not available in this setting | $2,151.83 | RVU18C |
| 2018-04-01 | Not available in this setting | $2,151.83 | RVU18B |
| 2018-01-01 | Not available in this setting | $2,151.83 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $2,129.26 | RVU17D |
| 2017-07-01 | Not available in this setting | $2,129.26 | RVU17C |
| 2017-04-01 | Not available in this setting | $2,129.26 | RVU17B |
| 2017-01-01 | Not available in this setting | $2,129.26 | RVU17A |
| 2016-10-01 | Not available in this setting | Rate data unavailable | RVU16D |
| 2016-07-01 | Not available in this setting | Rate data unavailable | RVU16C |
| 2016-04-01 | Not available in this setting | Rate data unavailable | RVU16B |
| 2016-01-01 | Not available in this setting | Rate data unavailable | RVU16A |
| 2015-10-01 | Not available in this setting | Rate data unavailable | RVU15D |
| 2015-07-01 | Not available in this setting | Rate data unavailable | RVU15C |
| 2015-04-01 | Not available in this setting | Rate data unavailable | RVU15B |
| 2015-01-01 | Not available in this setting | Rate data unavailable | RVU15A |
| 2014-10-01 | Not available in this setting | Rate data unavailable | RVU14D |
| 2014-07-01 | Not available in this setting | Rate data unavailable | RVU14C |
| 2014-04-01 | Not available in this setting | Rate data unavailable | RVU14B |
| 2014-01-01 | Not available in this setting | Rate data unavailable | 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 |
Where the Santa Maria, CA rate applies
Santa Maria, CA is a Medicare payment area, not a city. Our Census mapping connects it to 28 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Santa Barbara
- Santa Maria
- Ballard
- Buellton
- Carpinteria
- Casmalia
- Cuyama
- Eastern Goleta Valley
19369 billing questions
How is this different from a one-pedicle TRAM flap?
This code is for a TRAM flap supplied by two pedicles. Use the one-pedicle code when the operative technique uses one pedicle.
Does two-pedicle mean reconstruction of both breasts?
No. Two-pedicle describes the flap technique for a reconstruction. Modifier 50 represents a bilateral procedure when both breasts are reconstructed.
What operative documentation supports this code?
Document the abdominal tissue transferred, the pedicled flap technique, and use of two pedicles. Include the reconstructed side or sides.
Is routine postoperative flap care separately reported?
Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.
Can the mastectomy be reported with the reconstruction?
When mastectomy and immediate TRAM reconstruction are performed in the same session, the mastectomy may be reported with the reconstruction. CMS applies its multiple-procedure payment rule to same-session procedures.
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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