FeeBase
Log inGet started
Menu

Billing code 19368: TRAM reconstructionMedicare rate & RVUs

Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,886.48 for 19368 nationally in a facility.

Medicare rate · 19368

TRAM reconstruction

Swap in your local Medicare rate.

Work RVUs
33.05
Total RVUs
56.48
Global days
090

National rate · 2026

$1,886.48

Facility setting, before claim adjustments.

See every locality for 19368 → · 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 19368 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 19368 covers

This service reconstructs a breast with tissue from the lower abdomen that includes skin, fat, and rectus abdominis muscle. The surgeon transfers the single-pedicle TRAM flap and performs microvascular anastomosis to establish its blood supply at the recipient site. Plastic and reconstructive surgeons typically perform the procedure in a hospital operating room, often as reconstruction following mastectomy. The flap transfer and its microvascular anastomosis are central to distinguishing this service from a TRAM flap that remains attached to its native pedicle.

Report the code when the operative record supports a single-pedicle TRAM reconstruction with microvascular anastomosis. Documentation should identify the flap and pedicle, the transfer and anastomosis performed, and the reconstructed side or sides. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple 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 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 19368 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

19368 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,725.19
Alaska*Unavailable$2,383.72
ArizonaUnavailable$1,839.01
ArkansasUnavailable$1,705.48
AtlantaUnavailable$1,940.32
AustinUnavailable$1,898.75
BakersfieldUnavailable$1,882.55
Baltimore/Surr. CntysUnavailable$1,994.96
BeaumontUnavailable$1,819.95
BrazoriaUnavailable$1,844.93

19368 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
19368 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 19368 rate is calculated

Each of 19368’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 · 19368

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 33.05Practice expense 17.28Malpractice 6.15

56.4800 adjusted RVUs×$33.4009 conversion factor=$1,886.48

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

Payment rules and modifiers for 19368

19368 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19368

TRAM 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 · 19368

TRAM 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

19368 without 50 · national facility

$1,886.48

TRAM reconstruction

19368-50 · Bilateral: 150%

$2,829.72

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

19368 compared with similar codes

Compare codes

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

Swap in your local Medicare rate.

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

How to choose

19367Breast reconstruction
Both describe single-pedicle TRAM reconstruction; choose 19368 when the service includes microvascular anastomosis, and 19367 for the TRAM flap service without that distinction.
19369TRAM flap reconstruction
19369 describes a bipedicled TRAM flap. 19368 is the single-pedicle TRAM service with microvascular anastomosis.
19364Free-flap reconstruction
19364 covers breast reconstruction with a free flap generally; 19368 identifies the single-pedicle TRAM flap with microvascular anastomosis.
19361Breast reconstruction
19361 uses a latissimus dorsi flap. 19368 uses a single-pedicle TRAM flap from the lower abdomen with microvascular anastomosis.

Codes related to 19368

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

Codes related to 19368
CodeHow it relatesNational office range
Same family
19367Breast reconstructionSingle-pedicle TRAM reconstruction without the microvascular anastomosis distinction.No office rate
19369TRAM flap reconstructionTRAM reconstruction using a bipedicled flap rather than a single pedicle.No office rate
Used instead
19364Free-flap reconstructionBreast reconstruction using a free flap other than the specifically described TRAM service.No office rate
19361Breast reconstructionUses a latissimus dorsi flap instead of lower-abdominal TRAM tissue.No office rate
19357Breast reconstructionTissue-expander placement is a different reconstruction approach, often used in a staged plan.No office rate
Often billed with
19303MastectomyMay be performed in the same session when reconstruction follows mastectomy.No office rate

19368 billing questions

How does 19368 differ from 19367?

19368 describes a single-pedicle TRAM flap with microvascular anastomosis. 19367 is the single-pedicle TRAM flap service without that anastomosis distinction.

Is the microvascular anastomosis included?

Yes. It is part of the 19368 service, so the anastomosis used to transfer the TRAM flap is not a separate service under this code.

When would 19364 be considered instead?

19364 is used for breast reconstruction with a free flap other than the specifically described single-pedicle TRAM flap with microvascular anastomosis.

How is bilateral reconstruction handled?

CMS identifies this as a bilateral procedure: modifier 50 is paid at 150%. Document the reconstruction performed on each side.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 19368PPRRVU2026_Oct_nonQPP.csv, line 1,705 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 19368 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 19368 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →