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Billing code 19361: Breast reconstructionMedicare rate & RVUs

Reports breast reconstruction using a latissimus dorsi flap moved from the back to the chest, commonly after mastectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities558 Medicare services in 2024

Medicare pays $1,382.13 for 19361 nationally in a facility.

Medicare rate · 19361

Breast reconstruction

Swap in your local Medicare rate.

Work RVUs
22.78
Total RVUs
41.38
Global days
090

National rate · 2026

$1,382.13

Facility setting, before claim adjustments.

See every locality for 19361 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 19361 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

19361 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,260.20
Alaska*Unavailable$1,729.30
ArizonaUnavailable$1,346.68
ArkansasUnavailable$1,245.24
AtlantaUnavailable$1,420.86
AustinUnavailable$1,395.04
BakersfieldUnavailable$1,386.44
Baltimore/Surr. CntysUnavailable$1,463.15
BeaumontUnavailable$1,328.94
BrazoriaUnavailable$1,352.39

19361 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
19361 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

Swap in your local Medicare rate.

Work 22.78Practice expense 14.31Malpractice 4.29

41.3800 adjusted RVUs×$33.4009 conversion factor=$1,382.13

All indexes start 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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 19361

Breast reconstruction

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

19361 without 50 · national facility

$1,382.13

Breast reconstruction

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).

When to use modifier 50

19361 compared with similar codes

Compare codes

19361 vs 19364 vs 19367 vs 19357: national Medicare rates

Swap in your local Medicare rate.

  • 19361
    Breast reconstruction · 22.78 wRVU
    —
  • 19364
    Free-flap reconstruction · 41.52 wRVU
    —
  • 19367
    Breast reconstruction · 26.13 wRVU
    —
  • 19357
    Breast reconstruction · 14.47 wRVU
    —

How to choose

19364Free-flap reconstruction
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 reconstruction
Code 19367 describes reconstruction with a pedicled TRAM flap from the abdomen. Code 19361 uses latissimus dorsi tissue from the back.
19357Breast reconstruction
Code 19357 is for tissue-expander placement, not reconstruction with a latissimus dorsi flap.

Codes related to 19361

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

Codes related to 19361
CodeHow it relatesNational office range
Used instead
19364Free-flap reconstructionBreast reconstruction using a free flap rather than a pedicled latissimus flap.No office rate
19367Breast reconstructionBreast reconstruction using a pedicled TRAM flap instead of latissimus tissue.No office rate
19357Breast reconstructionTissue-expander placement is a different reconstructive approach, often used in staged reconstruction.No office rate

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
RVUs for 19361PPRRVU2026_Oct_nonQPP.csv, line 1,702 (RVU26D)

Open CMS sourceHow we calculate rates

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