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Billing code 19371: CapsulectomyMedicare rate & RVUs

Reports complete removal of the capsule surrounding a breast implant, including its contents, when the surgeon performs a full capsulectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities4.7K Medicare services in 2024

Medicare pays $649.31 for 19371 nationally in a facility.

Medicare rate · 19371

Capsulectomy

Work RVUs
9.73
Total RVUs
19.44
Global days
090

National rate · 2026

$649.31

Facility setting, before claim adjustments.

See every locality for 19371 →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 19371 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 19371 covers

This operation removes the fibrous capsule surrounding a breast implant in its entirety and removes material contained within that capsule, including the implant. Plastic and reconstructive surgeons commonly perform it in an operating room for a contracted capsule, an implant-related complication, or a revision in which complete capsule removal is intended. The code describes capsule excision, not simple implant removal or a limited capsule release.

Report the service for each breast treated. The operative note should establish complete rather than partial capsule removal, identify the side, and describe the capsule and intracapsular contents removed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. CMS does not pay an assistant at surgery for this service; co-surgeons and team surgery are 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 19371 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

19371 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$589.78
Alaska*Unavailable$801.30
ArizonaUnavailable$632.31
ArkansasUnavailable$582.44
AtlantaUnavailable$666.85
AustinUnavailable$658.20
BakersfieldUnavailable$656.69
Baltimore/Surr. CntysUnavailable$688.27
BeaumontUnavailable$621.29
BrazoriaUnavailable$636.03

19371 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
19371 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 19371 rate is calculated

Each of 19371’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 · 19371

RVUs × geographic indexes × conversion factor

Work9.73

9.73 RVUs× 1.000 GPCI

Practice expense7.87

7.87 RVUs× 1.000 GPCI

Malpractice1.84

1.84 RVUs× 1.000 GPCI

Adjusted RVUs

19.4400

Conversion factor

$33.4009

Medicare rate

$649.31

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

Payment rules and modifiers for 19371

19371 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19371

Capsulectomy

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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
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 · 19371

Capsulectomy

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

19371 without 50 · national facility

$649.31

Capsulectomy

19371-50 · Bilateral: 150%

$973.96

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

19371 compared with similar codes

Compare codes · National

5 codes, side by side

  • 19371

    Capsulectomy9.73 wRVU

    Not priced

  • 19370

    Capsule revision8.94 wRVU

    Not priced

  • 19328

    Implant removal7.25 wRVU

    Not priced

  • 19330

    Implant removal8.78 wRVU

    Not priced

  • 19342

    Breast implant10.22 wRVU

    Not priced

How to choose

19370Capsule revision
Use 19371 for complete capsule removal with intracapsular contents. Use 19370 when the capsule is revised but not completely excised.
19328Implant removal
19328 describes removal of an intact implant. 19371 includes implant removal when the surgeon also performs complete capsulectomy.
19330Implant removal
19330 describes removal of a ruptured implant. 19371 is distinguished by complete excision of the surrounding capsule as well as removal of its contents.
19342Breast implant
19342 describes insertion or replacement of an implant; 19371 describes complete removal of the peri-implant capsule and existing intracapsular contents.

Codes related to 19371

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

Codes related to 19371
CodeHow it relatesNational office range
Same family
19370Capsule revisionCapsule revision for work short of complete peri-implant capsulectomy.No office rate
Used instead
19328Implant removalRemoval of an intact implant when complete capsule excision is not performed.No office rate
19330Implant removalRemoval of a ruptured implant when complete capsule excision is not performed.No office rate
Often billed with
19342Breast implantMay describe placement of a replacement implant after capsule removal.No office rate

19371 billing questions

How does 19371 differ from 19370?

19371 is for complete removal of the peri-implant capsule and its contents. 19370 describes revision of the capsule when the work is not a complete capsulectomy.

Does 19371 include removal of the implant?

Yes. Removal of the implant within the capsule is included, so do not separately report 19328 or 19330 for that same removal.

Can 19371 be reported when a new implant is placed?

19371 covers the complete capsule removal and removal of the existing implant. When a replacement implant is placed, 19342 may describe that placement when its requirements are met.

How is bilateral capsulectomy reported?

Report modifier 50 when the complete procedure is performed on both breasts. CMS pays bilateral 19371 at 150%.

What should the operative note document?

Document the side treated, the extent of capsule excision, and removal of the implant or other intracapsular contents. The record should distinguish complete excision from a limited capsule revision.

Is an assistant surgeon payable for 19371?

CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 19371PPRRVU2026_Oct_nonQPP.csv, line 1,708 (RVU26D)

Open CMS sourceHow we calculate rates

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