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Billing code 19380: Breast revisionMedicare rate & RVUs

Reports substantial surgical correction of a previously reconstructed breast, such as reshaping a flap or correcting contour and symmetry problems.

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

Medicare pays $735.82 for 19380 nationally in a facility.

Medicare rate · 19380

Breast revision

Swap in your local Medicare rate.

Work RVUs
10.89
Total RVUs
22.03
Global days
090

National rate · 2026

$735.82

Facility setting, before claim adjustments.

See every locality for 19380 → · 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 19380 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 19380 covers

This service covers a substantial surgical revision to a breast reconstructed after mastectomy, whether the reconstruction used an implant or the patient’s own tissue. A plastic or reconstructive surgeon may reshape the breast, remove excess tissue or skin, reposition or advance a flap, or correct a significant contour or symmetry problem. These operations are commonly performed in a hospital outpatient department or ambulatory surgery center.

Report 19380 when the surgeon performs substantive reconstructive correction, supported by an operative note describing the problem and the work performed. A focused implant or capsule operation, or nipple-areola reconstruction alone, may call for a more specific code. 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 other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 19380 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

19380 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$668.15
Alaska*Unavailable$906.68
ArizonaUnavailable$716.55
ArkansasUnavailable$659.80
AtlantaUnavailable$755.53
AustinUnavailable$746.35
BakersfieldUnavailable$745.11
Baltimore/Surr. CntysUnavailable$780.03
BeaumontUnavailable$703.64
BrazoriaUnavailable$720.94

19380 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
19380 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 19380 rate is calculated

Each of 19380’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 · 19380

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.89Practice expense 9.09Malpractice 2.05

22.0300 adjusted RVUs×$33.4009 conversion factor=$735.82

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

Payment rules and modifiers for 19380

19380 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19380

Breast revision

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 · 19380

Breast revision

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

19380 without 50 · national facility

$735.82

Breast revision

19380-50 · Bilateral: 150%

$1,103.73

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

19380 compared with similar codes

Compare codes

19380 vs 19370 vs 19371 vs 19342 vs 19350: national Medicare rates

Swap in your local Medicare rate.

  • 19380
    Breast revision · 10.89 wRVU
    —
  • 19370
    Capsule revision · 8.94 wRVU
    —
  • 19371
    Capsulectomy · 9.73 wRVU
    —
  • 19342
    Breast implant · 10.22 wRVU
    —
  • 19350
    Nipple reconstruction · 8.88 wRVU
    $893.81

How to choose

19370Capsule revision
19370 describes capsule revision around a breast implant. Choose 19380 when the operation substantially revises the reconstructed breast beyond a focused capsule procedure.
19371Capsulectomy
19371 describes removal of the peri-implant capsule. Use 19380 for broader reconstructive reshaping or correction rather than capsule removal alone.
19342Breast implant
19342 is for implant insertion or replacement after a prior reconstruction. 19380 is for substantial revision of the reconstructed breast, not simply the implant exchange.
19350Nipple reconstruction
19350 is for nipple-areola reconstruction. 19380 applies to broader revision of the reconstructed breast rather than nipple-areola reconstruction alone.

Codes related to 19380

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

Codes related to 19380
CodeHow it relatesNational office range
Used instead
19370Capsule revisionCapsule revision is a more focused service than substantial revision of the reconstructed breast.No office rate
19371CapsulectomyCapsule removal is a distinct, more specifically defined operation when that is the work performed.No office rate
19342Breast implantUse for implant insertion or replacement after a prior reconstruction when that is the principal service.No office rate
19350Nipple reconstructionCovers nipple-areola reconstruction when the work is limited to that specific site.$790.41–$1,139.86
19316Breast liftMastopexy addresses breast lifting rather than substantial revision of a reconstructed breast.No office rate

19380 billing questions

When should 19380 be chosen instead of an implant or capsule code?

Use 19380 for substantial revision of the reconstructed breast as a whole, such as reshaping or flap advancement. A procedure focused on implant exchange or capsule work may fit a more specific code, depending on the operation performed.

Can nipple-areola reconstruction be reported as 19380?

Nipple-areola reconstruction alone is more specifically described by 19350. The operative report should make clear whether the service was limited to nipple-areola reconstruction or involved a broader breast revision.

How is bilateral revision reported?

CMS identifies 19380 as a bilateral procedure; reporting modifier 50 results in payment at 150%.

What postoperative care is included?

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

Can an assistant or co-surgeon be paid for 19380?

CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeon and team-surgery payment 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 19380PPRRVU2026_Oct_nonQPP.csv, line 1,709 (RVU26D)

Open CMS sourceHow we calculate rates

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