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Billing code 19369: TRAM flap reconstructionMedicare rate & RVUs

Reports breast reconstruction using a pedicled abdominal TRAM flap supplied by two pedicles, typically after mastectomy when autologous tissue is selected.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,755.89 for 19369 nationally in a facility.

Medicare rate · 19369

TRAM flap reconstruction

Work RVUs
30.53
Total RVUs
52.57
Global days
090

National rate · 2026

$1,755.89

Facility setting, before claim adjustments.

See every locality for 19369 →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 19369 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 19369 covers

A surgeon transfers lower abdominal skin, fat, and associated rectus muscle to create a breast mound, maintaining blood supply through two pedicles. Plastic surgeons commonly perform this reconstruction after mastectomy, either during the mastectomy operation or as a later procedure. The operative report should identify the abdominal tissue transferred and document the two-pedicle technique; this is distinct from a free flap transferred with microvascular reconnection.

Select this code for the two-pedicle TRAM approach, rather than a one-pedicle TRAM or another flap method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%. An assistant at surgery may be paid; 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 19369 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

19369 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,605.24
Alaska*Unavailable$2,216.09
ArizonaUnavailable$1,711.63
ArkansasUnavailable$1,586.82
AtlantaUnavailable$1,805.82
AustinUnavailable$1,767.99
BakersfieldUnavailable$1,753.54
Baltimore/Surr. CntysUnavailable$1,857.05
BeaumontUnavailable$1,693.24
BrazoriaUnavailable$1,717.39

19369 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
19369 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 19369 rate is calculated

Each of 19369’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 · 19369

RVUs × geographic indexes × conversion factor

Work30.53

30.53 RVUs× 1.000 GPCI

Practice expense16.36

16.36 RVUs× 1.000 GPCI

Malpractice5.68

5.68 RVUs× 1.000 GPCI

Adjusted RVUs

52.5700

Conversion factor

$33.4009

Medicare rate

$1,755.89

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 19369

19369 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19369

TRAM 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 · 19369

TRAM 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.

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

19369 without 50 · national facility

$1,755.89

TRAM flap reconstruction

19369-50 · Bilateral: 150%

$2,633.84

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

19369 compared with similar codes

Compare codes · National

5 codes, side by side

  • 19369

    TRAM flap reconstruction30.53 wRVU

    Not priced

  • 19367

    Breast reconstruction26.13 wRVU

    Not priced

  • 19368

    TRAM reconstruction33.05 wRVU

    Not priced

  • 19364

    Free-flap reconstruction41.52 wRVU

    Not priced

  • 19361

    Breast reconstruction22.78 wRVU

    Not priced

How to choose

19367Breast reconstruction
Choose 19367 for a one-pedicle TRAM flap. Code 19369 identifies the two-pedicle technique.
19368TRAM reconstruction
Code 19368 describes a one-pedicle TRAM flap with microvascular anastomosis; 19369 is the two-pedicle TRAM approach.
19364Free-flap reconstruction
Code 19364 is for free-flap breast reconstruction, in which tissue is transferred and reconnected microsurgically. Code 19369 uses a pedicled TRAM flap.
19361Breast reconstruction
Code 19361 uses a latissimus dorsi flap from the back. Code 19369 uses pedicled abdominal TRAM tissue.

Codes related to 19369

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

Codes related to 19369
CodeHow it relatesNational office range
Same family
19367Breast reconstructionOne-pedicle TRAM flap reconstruction, rather than the two-pedicle technique.No office rate
19368TRAM reconstructionOne-pedicle TRAM reconstruction with microvascular anastomosis.No office rate
Used instead
19364Free-flap reconstructionUses a free flap with microvascular transfer instead of a pedicled TRAM flap.No office rate
19361Breast reconstructionUses a latissimus dorsi flap rather than abdominal TRAM tissue.No office rate
19357Breast reconstructionUses a tissue expander as a staged reconstruction approach instead of a TRAM flap.No office rate
Often billed with
19303MastectomyMay be reported for mastectomy performed in the same session as immediate reconstruction.No office rate

19369 billing questions

How is this different from a one-pedicle TRAM flap?

This code is for a TRAM flap supplied by two pedicles. Use the one-pedicle code when the operative technique uses one pedicle.

Does two-pedicle mean reconstruction of both breasts?

No. Two-pedicle describes the flap technique for a reconstruction. Modifier 50 represents a bilateral procedure when both breasts are reconstructed.

What operative documentation supports this code?

Document the abdominal tissue transferred, the pedicled flap technique, and use of two pedicles. Include the reconstructed side or sides.

Is routine postoperative flap care separately reported?

Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.

Can the mastectomy be reported with the reconstruction?

When mastectomy and immediate TRAM reconstruction are performed in the same session, the mastectomy may be reported with the reconstruction. CMS applies its multiple-procedure payment rule to same-session procedures.

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 19369PPRRVU2026_Oct_nonQPP.csv, line 1,706 (RVU26D)

Open CMS sourceHow we calculate rates

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