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Billing code 19364: Free-flap reconstructionMedicare rate & RVUs

Reports breast reconstruction using a free flap of the patient’s own tissue, transferred to the chest and connected through microsurgical vessel anastomoses.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.3K Medicare services in 2024

Medicare pays $2,369.46 for 19364 nationally in a facility.

Medicare rate · 19364

Free-flap reconstruction

Swap in your local Medicare rate.

Work RVUs
41.52
Total RVUs
70.94
Global days
090

National rate · 2026

$2,369.46

Facility setting, before claim adjustments.

See every locality for 19364 → · 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 19364 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 19364 covers

Code 19364 represents autologous breast reconstruction using tissue detached from a donor site and transferred to the chest, with its blood vessels connected microsurgically. Plastic and reconstructive surgeons commonly use abdominal perforator tissue, such as a DIEP flap; selected cases use tissue from the thigh or buttock. Reconstruction may be performed during mastectomy or later, typically in a hospital operating room.

Report the service for the free-flap reconstruction, not for a pedicled flap that remains attached to its original blood supply. The operative report should identify the flap and donor site, document the transfer and vascular connections, and specify the reconstructed side. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. For same-session 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 available; co-surgeons require 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 19364 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

19364 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,164.78
Alaska*Unavailable$2,990.59
ArizonaUnavailable$2,309.07
ArkansasUnavailable$2,139.79
AtlantaUnavailable$2,438.34
AustinUnavailable$2,383.67
BakersfieldUnavailable$2,361.15
Baltimore/Surr. CntysUnavailable$2,506.82
BeaumontUnavailable$2,286.05
BrazoriaUnavailable$2,315.82

19364 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
19364 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 19364 rate is calculated

Each of 19364’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 · 19364

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 41.52Practice expense 21.49Malpractice 7.93

70.9400 adjusted RVUs×$33.4009 conversion factor=$2,369.46

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 19364

19364 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19364

Free-flap 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 · 19364

Free-flap 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

19364 without 50 · national facility

$2,369.46

Free-flap reconstruction

19364-50 · Bilateral: 150%

$3,554.19

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

19364 compared with similar codes

Compare codes

19364 vs 19361 vs 19367 vs 19368 vs 19357: national Medicare rates

Swap in your local Medicare rate.

  • 19364
    Free-flap reconstruction · 41.52 wRVU
    —
  • 19361
    Breast reconstruction · 22.78 wRVU
    —
  • 19367
    Breast reconstruction · 26.13 wRVU
    —
  • 19368
    TRAM reconstruction · 33.05 wRVU
    —
  • 19357
    Breast reconstruction · 14.47 wRVU
    —

How to choose

19361Breast reconstruction
Use 19361 for reconstruction with a pedicled latissimus dorsi flap. Code 19364 describes transfer of free tissue with microsurgical vascular connections.
19367Breast reconstruction
Code 19367 describes a single-pedicle TRAM flap without microvascular anastomosis; 19364 is for free-flap transfer.
19368TRAM reconstruction
Code 19368 is specific to a single-pedicle TRAM reconstruction with microvascular anastomosis. Select 19364 when the documented free flap is not reported under that specific TRAM code.
19357Breast reconstruction
Code 19357 reports placement of a tissue expander, commonly as a staged implant-based approach; 19364 reports reconstruction with transferred autologous free tissue.

Codes related to 19364

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

Codes related to 19364
CodeHow it relatesNational office range
Often billed with
19303MastectomyMay be reported with immediate free-flap reconstruction performed during the same mastectomy session.No office rate
Used instead
19361Breast reconstructionUses a pedicled latissimus dorsi flap rather than free tissue transfer.No office rate
19367Breast reconstructionReports breast reconstruction with a single-pedicle TRAM flap without microvascular anastomosis.No office rate
19368TRAM reconstructionApplies to a single-pedicle TRAM reconstruction with microvascular anastomosis.No office rate
19357Breast reconstructionReports tissue-expander placement for a staged implant-based reconstruction approach.No office rate

19364 billing questions

How does 19364 differ from a pedicled TRAM flap?

Code 19364 is for tissue completely detached and transferred as a free flap, with microsurgical vessel connections. A pedicled TRAM flap remains attached to its original blood supply and is reported using the applicable TRAM code.

Can 19364 be reported with a mastectomy?

Yes. Immediate free-flap reconstruction may be performed in the same session as a mastectomy, with each service reported when supported by the operative documentation.

How is bilateral free-flap reconstruction reported?

When reconstruction is performed on both breasts, report the bilateral procedure with modifier 50. CMS payment for the bilateral procedure is 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care. Routine follow-up for the reconstruction during that period is part of the global service.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeons are paid only when supporting documentation is provided; 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 19364PPRRVU2026_Oct_nonQPP.csv, line 1,703 (RVU26D)

Open CMS sourceHow we calculate rates

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