No office rate
Use reduction mammoplasty when breast volume is reduced through tissue removal and reshaping. Mastopexy focuses on lifting and reshaping without the same volume-reduction objective.
On this page
CMS RVU26D · Effective 2026-10-01
19318 Breast reduction Medicare reimbursement rates
Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume. Compare 19318 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 19318?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 19318 pays more and less
Plastic surgery
About 19318: Reduction mammoplasty
Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume.
This operation reduces breast volume by removing tissue and skin and reshaping the remaining breast. It is commonly performed for symptomatic macromastia, such as breast-related neck, back, or shoulder discomfort, shoulder grooving, or recurrent skin irritation. A plastic surgeon or another surgeon with breast surgery expertise typically performs the procedure in a hospital or ambulatory surgery setting. The operative report should describe the tissue removal, reshaping, laterality, and clinical rationale.
Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies a 50% reduction to the others. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19318
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.63 · 53%
- Practice expense (office) RVU10.76 · 37%
- Malpractice RVU2.96 · 10%
6.7K
Medicare services in 2024 · #1687 by national volume
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.
19318 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$557.92–$824.91
This code is for breast reduction, commonly for symptomatic macromastia. Code 19300 describes surgical treatment of gynecomastia.
No office rate
Reduction mammoplasty removes breast volume; code 19325 is used for breast augmentation with an implant.
No office rate
Reduction mammoplasty addresses breast volume and contour. Code 19301 is used for partial removal of the breast, such as for a breast lesion.
See how rates vary across the country
19318 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | 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 |
Compare 19318 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $892.48 |
| Alaska* | Office Unavailable | Facility $1220.31 |
| Arizona | Office Unavailable | Facility $954.94 |
| Arkansas | Office Unavailable | Facility $881.69 |
| Atlanta | Office Unavailable | Facility $1007.51 |
| Austin | Office Unavailable | Facility $990.93 |
| Bakersfield | Office Unavailable | Facility $986.08 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1038.34 |
| Beaumont | Office Unavailable | Facility $940.95 |
| Brazoria | Office Unavailable | Facility $959.51 |
| Chicago | Office Unavailable | Facility $1113.80 |
| Chico | Office Unavailable | Facility $977.82 |
| Colorado | Office Unavailable | Facility $987.93 |
| Connecticut | Office Unavailable | Facility $1039.19 |
| Dallas | Office Unavailable | Facility $969.54 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1083.65 |
| Delaware | Office Unavailable | Facility $968.63 |
| Detroit | Office Unavailable | Facility $1035.56 |
| East St. Louis | Office Unavailable | Facility $1051.82 |
| El Centro | Office Unavailable | Facility $978.31 |
| Fort Lauderdale | Office Unavailable | Facility $1064.87 |
| Fort Worth | Office Unavailable | Facility $967.23 |
| Fresno | Office Unavailable | Facility $977.82 |
| Galveston | Office Unavailable | Facility $964.97 |
| Hanford-Corcoran | Office Unavailable | Facility $977.82 |
| Hawaii, Guam | Office Unavailable | Facility $987.93 |
| Houston | Office Unavailable | Facility $1019.15 |
| Idaho | Office Unavailable | Facility $899.46 |
| Indiana | Office Unavailable | Facility $903.26 |
| Iowa | Office Unavailable | Facility $890.15 |
| Kansas | Office Unavailable | Facility $896.78 |
| Kentucky | Office Unavailable | Facility $932.02 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1034.27 |
| Madera | Office Unavailable | Facility $977.82 |
| Manhattan | Office Unavailable | Facility $1129.89 |
| Merced | Office Unavailable | Facility $977.82 |
| Metropolitan Boston | Office Unavailable | Facility $1060.57 |
| Metropolitan Kansas City | Office Unavailable | Facility $956.12 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1023.53 |
| Metropolitan St. Louis | Office Unavailable | Facility $963.26 |
| Miami | Office Unavailable | Facility $1146.22 |
| Minnesota | Office Unavailable | Facility $921.14 |
| Mississippi | Office Unavailable | Facility $904.56 |
| Modesto | Office Unavailable | Facility $977.82 |
| Montana** | Office Unavailable | Facility $980.12 |
| Napa | Office Unavailable | Facility $1078.85 |
| Nebraska | Office Unavailable | Facility $891.15 |
| Nevada** | Office Unavailable | Facility $964.17 |
| New Hampshire | Office Unavailable | Facility $982.69 |
| New Mexico | Office Unavailable | Facility $970.36 |
| New Orleans | Office Unavailable | Facility $972.56 |
| North Carolina | Office Unavailable | Facility $920.55 |
| North Dakota** | Office Unavailable | Facility $921.59 |
| Northern Nj | Office Unavailable | Facility $1077.43 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1166.38 |
| Ohio | Office Unavailable | Facility $949.84 |
| Oklahoma | Office Unavailable | Facility $919.81 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1023.07 |
| Portland | Office Unavailable | Facility $1003.25 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1058.71 |
| Puerto Rico | Office Unavailable | Facility $982.79 |
| Queens | Office Unavailable | Facility $1122.84 |
| Redding | Office Unavailable | Facility $977.82 |
| Rest Of California | Office Unavailable | Facility $977.82 |
| Rest Of Florida | Office Unavailable | Facility $1014.23 |
| Rest Of Georgia | Office Unavailable | Facility $960.48 |
| Rest Of Illinois | Office Unavailable | Facility $1004.71 |
| Rest Of Louisiana | Office Unavailable | Facility $934.83 |
| Rest Of Maine | Office Unavailable | Facility $914.19 |
| Rest Of Maryland | Office Unavailable | Facility $981.74 |
| Rest Of Massachusetts | Office Unavailable | Facility $987.65 |
| Rest Of Michigan | Office Unavailable | Facility $961.80 |
| Rest Of Missouri | Office Unavailable | Facility $928.15 |
| Rest Of New Jersey | Office Unavailable | Facility $1043.85 |
| Rest Of New York | Office Unavailable | Facility $932.98 |
| Rest Of Oregon | Office Unavailable | Facility $949.52 |
| Rest Of Pennsylvania | Office Unavailable | Facility $945.41 |
| Rest Of Texas | Office Unavailable | Facility $952.40 |
| Rest Of Washington | Office Unavailable | Facility $982.52 |
| Rhode Island | Office Unavailable | Facility $991.42 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1009.68 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1011.82 |
| Salinas | Office Unavailable | Facility $1007.77 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1021.14 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1123.78 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1120.41 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1150.72 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1136.98 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $993.27 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1022.68 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1008.72 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1032.05 |
| Seattle (King Cnty) | Office Unavailable | Facility $1069.91 |
| South Carolina | Office Unavailable | Facility $938.17 |
| South Dakota** | Office Unavailable | Facility $914.67 |
| Southern Maine | Office Unavailable | Facility $940.60 |
| Stockton | Office Unavailable | Facility $977.82 |
| Suburban Chicago | Office Unavailable | Facility $1070.00 |
| Tennessee | Office Unavailable | Facility $901.84 |
| Utah | Office Unavailable | Facility $948.67 |
| Vallejo | Office Unavailable | Facility $1074.01 |
| Vermont | Office Unavailable | Facility $927.88 |
| Virgin Islands | Office Unavailable | Facility $982.79 |
| Virginia | Office Unavailable | Facility $945.14 |
| Visalia | Office Unavailable | Facility $977.82 |
| West Virginia | Office Unavailable | Facility $975.85 |
| Wisconsin | Office Unavailable | Facility $896.81 |
| Wyoming** | Office Unavailable | Facility $954.61 |
| Yuba City | Office Unavailable | Facility $977.82 |
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19318 billing questions
How is breast reduction different from mastopexy?
Reduction mammoplasty removes breast tissue and reduces volume while reshaping the breast. Mastopexy (19316) lifts and reshapes the breast without the same volume-reduction purpose.
How should bilateral breast reduction be reported?
Report modifier 50 for bilateral surgery. CMS pays the bilateral procedure at 150%.
Does the 90-day global period include routine postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
CMS permits payment for an assistant at surgery. Co-surgeon payment requires supporting documentation.
How does CMS handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and the other procedure or procedures are subject to the standard multiple procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,69019306,,Mast rad urban type,A,,17.68,12.83,NA,12.83,,4.73,35.24,35.24,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69119307,,Mast mod rad,A,,17.54,11.66,NA,11.66,,4.53,33.73,33.73,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69219316,,Mastopexy,A,,10.81,8.89,NA,8.89,,2.13,21.83,21.83,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69319318,,Breast reduction,A,,15.63,10.76,NA,10.76,,2.96,29.35,29.35,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69419325,,Breast augmentation w/implt,A,,7.92,7.55,NA,7.55,,1.48,16.95,16.95,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69519328,,Rmvl intact breast implant,A,,7.25,6.72,NA,6.72,,1.40,15.37,15.37,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69619330,,Rmvl ruptured breast implant,A,,8.78,7.27,NA,7.27,,1.69,17.74,17.74,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00