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Billing code 19367: Breast reconstructionMedicare rate & RVUs

Reports breast reconstruction using an abdominal single-pedicle TRAM flap, typically after mastectomy, when the flap remains attached to its vascular supply.

CMS RVU26DEffective Oct 1, 2026109 payment localities24 Medicare services in 2024

Medicare pays $1,559.15 for 19367 nationally in a facility.

Medicare rate · 19367

Breast reconstruction

Swap in your local Medicare rate.

Work RVUs
26.13
Total RVUs
46.68
Global days
090

National rate · 2026

$1,559.15

Facility setting, before claim adjustments.

See every locality for 19367 → · 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 19367 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 19367 covers

The surgeon uses skin, fat, and a portion of rectus abdominis muscle from the abdomen to form a breast mound. The flap is tunneled to the chest while remaining connected to its original blood supply; this distinguishes the service from a free flap requiring microvascular reconnection. Plastic surgeons commonly perform this reconstruction after mastectomy in a hospital or other facility setting. The abdominal donor site is also closed as part of the reconstructive operation.

Select this code for the single-pedicle TRAM approach without microvascular anastomosis; a single-pedicle flap with microvascular anastomosis and a two-pedicle flap have separate codes. Document the flap technique, laterality, and reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, 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 allowed; 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 19367 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

19367 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,423.30
Alaska*Unavailable$1,956.89
ArizonaUnavailable$1,519.57
ArkansasUnavailable$1,406.65
AtlantaUnavailable$1,602.72
AustinUnavailable$1,572.85
BakersfieldUnavailable$1,562.74
Baltimore/Surr. CntysUnavailable$1,649.79
BeaumontUnavailable$1,500.46
BrazoriaUnavailable$1,525.78

19367 rates by state

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

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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
19367 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 19367 rate is calculated

Each of 19367’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 · 19367

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 26.13Practice expense 15.70Malpractice 4.85

46.6800 adjusted RVUs×$33.4009 conversion factor=$1,559.15

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

Payment rules and modifiers for 19367

19367 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19367

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 · 19367

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

19367 without 50 · national facility

$1,559.15

Breast reconstruction

19367-50 · Bilateral: 150%

$2,338.73

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

19367 compared with similar codes

Compare codes

19367 vs 19368 vs 19369 vs 19364 vs 19361: national Medicare rates

Swap in your local Medicare rate.

  • 19367
    Breast reconstruction · 26.13 wRVU
    —
  • 19368
    TRAM reconstruction · 33.05 wRVU
    —
  • 19369
    TRAM flap reconstruction · 30.53 wRVU
    —
  • 19364
    Free-flap reconstruction · 41.52 wRVU
    —
  • 19361
    Breast reconstruction · 22.78 wRVU
    —

How to choose

19368TRAM reconstruction
Both use a single-pedicle TRAM flap. Choose 19368 when the flap is transferred with microvascular anastomosis; 19367 is the pedicled approach without that anastomosis.
19369TRAM flap reconstruction
19369 describes a two-pedicle TRAM flap. For 19367, the reconstruction uses one pedicle.
19364Free-flap reconstruction
19364 is reconstruction with a free flap, which requires microvascular reconnection. In 19367, the TRAM flap remains attached to its original blood supply.
19361Breast reconstruction
19361 uses tissue from the latissimus dorsi in the back; 19367 uses abdominal tissue and rectus muscle.

Codes related to 19367

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

Codes related to 19367
CodeHow it relatesNational office range
Same family
19368TRAM reconstructionSingle-pedicle TRAM reconstruction with microvascular anastomosis.No office rate
19369TRAM flap reconstructionTRAM reconstruction using two pedicles.No office rate
Used instead
19364Free-flap reconstructionBreast reconstruction using a free flap rather than a pedicled TRAM flap.No office rate
19361Breast reconstructionUses a latissimus dorsi flap instead of abdominal TRAM tissue.No office rate
19357Breast reconstructionUses tissue-expander placement for reconstruction rather than a TRAM flap.No office rate
Often billed with
19303MastectomyMay be reported for a complete mastectomy performed in the same session.No office rate

19367 billing questions

How is 19367 distinguished from 19368?

19367 describes a single-pedicle TRAM flap that remains connected to its blood supply. Use 19368 when the single-pedicle flap involves microvascular anastomosis.

When is 19369 used instead?

19369 is for breast reconstruction using a two-pedicle TRAM flap. The number of pedicles used, rather than the size of the reconstruction, distinguishes it from 19367.

Can the mastectomy be reported in the same session?

The mastectomy and the TRAM-flap reconstruction are distinct services and may be reported for the same session when both are performed. For same-session procedures, CMS applies the standard multiple procedure reduction.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. The operative record should identify the flap method and laterality.

How is bilateral reconstruction handled?

CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%. Document the reconstruction performed on each side.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be allowed. 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 19367PPRRVU2026_Oct_nonQPP.csv, line 1,704 (RVU26D)

Open CMS sourceHow we calculate rates

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