No office rate
Both describe single-pedicle TRAM reconstruction; choose 19368 when the service includes microvascular anastomosis, and 19367 for the TRAM flap service without that distinction.
On this page
CMS RVU26D · Effective 2026-10-01
19368 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1864.33
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Breast reconstruction
About 19368: Single-pedicle TRAM breast reconstruction with anastomosis
Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy.
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.
CMS billing rules for 19368
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU33.05 · 59%
- Practice expense (office) RVU17.28 · 31%
- Malpractice RVU6.15 · 11%
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.
19368 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
19369 describes a bipedicled TRAM flap. 19368 is the single-pedicle TRAM service with microvascular anastomosis.
No office rate
19364 covers breast reconstruction with a free flap generally; 19368 identifies the single-pedicle TRAM flap with microvascular anastomosis.
No office rate
19361 uses a latissimus dorsi flap. 19368 uses a single-pedicle TRAM flap from the lower abdomen with microvascular anastomosis.
The same code, a different location
How does Delaware compare?
19368 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 19368
Office
Unavailable
Facility
$1725.19
No comparable office rate is available.
Arkansas
Arkansas · 19368
Office
Unavailable
Facility
$1705.48
No comparable office rate is available.
Arizona
Arizona · 19368
Office
Unavailable
Facility
$1839.01
No comparable office rate is available.
Bakersfield
California · 19368
Office
Unavailable
Facility
$1882.55
No comparable office rate is available.
Chico
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
El Centro
California · 19368
Office
Unavailable
Facility
$1866.37
No comparable office rate is available.
Fresno
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Hanford-Corcoran
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Madera
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Merced
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Modesto
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Napa
California · 19368
Office
Unavailable
Facility
$2038.50
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 19368
Office
Unavailable
Facility
$1944.99
No comparable office rate is available.
Redding
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Rest Of California
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 19368
Office
Unavailable
Facility
$1931.57
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 19368
Office
Unavailable
Facility
$1924.99
No comparable office rate is available.
Salinas
California · 19368
Office
Unavailable
Facility
$1917.16
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 19368
Office
Unavailable
Facility
$1938.64
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 19368
Office
Unavailable
Facility
$2116.86
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 19368
Office
Unavailable
Facility
$2109.88
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 19368
Office
Unavailable
Facility
$2167.71
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 19368
Office
Unavailable
Facility
$2139.15
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 19368
Office
Unavailable
Facility
$1890.16
No comparable office rate is available.
Santa Cruz-Watsonville
California · 19368
Office
Unavailable
Facility
$1938.44
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 19368
Office
Unavailable
Facility
$1917.89
No comparable office rate is available.
Santa Rosa-Petaluma
California · 19368
Office
Unavailable
Facility
$1955.88
No comparable office rate is available.
Stockton
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Vallejo
California · 19368
Office
Unavailable
Facility
$2028.44
No comparable office rate is available.
Visalia
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Yuba City
California · 19368
Office
Unavailable
Facility
$1865.34
No comparable office rate is available.
Colorado
Colorado · 19368
Office
Unavailable
Facility
$1891.68
No comparable office rate is available.
Connecticut
Connecticut · 19368
Office
Unavailable
Facility
$1996.14
No comparable office rate is available.
Fort Lauderdale
Florida · 19368
Office
Unavailable
Facility
$2059.96
No comparable office rate is available.
Rest Of Florida
Florida · 19368
Office
Unavailable
Facility
$1964.41
No comparable office rate is available.
Atlanta
Georgia · 19368
Office
Unavailable
Facility
$1940.32
No comparable office rate is available.
Rest Of Georgia
Georgia · 19368
Office
Unavailable
Facility
$1863.59
No comparable office rate is available.
Hawaii, Guam
Hawaii · 19368
Office
Unavailable
Facility
$1879.07
No comparable office rate is available.
Iowa
Iowa · 19368
Office
Unavailable
Facility
$1713.56
No comparable office rate is available.
Idaho
Idaho · 19368
Office
Unavailable
Facility
$1732.06
No comparable office rate is available.
East St. Louis
Illinois · 19368
Office
Unavailable
Facility
$2048.60
No comparable office rate is available.
Rest Of Illinois
Illinois · 19368
Office
Unavailable
Facility
$1951.92
No comparable office rate is available.
Suburban Chicago
Illinois · 19368
Office
Unavailable
Facility
$2068.37
No comparable office rate is available.
Indiana
Indiana · 19368
Office
Unavailable
Facility
$1738.77
No comparable office rate is available.
Kansas
Kansas · 19368
Office
Unavailable
Facility
$1729.19
No comparable office rate is available.
Kentucky
Kentucky · 19368
Office
Unavailable
Facility
$1804.96
No comparable office rate is available.
New Orleans
Louisiana · 19368
Office
Unavailable
Facility
$1880.37
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 19368
Office
Unavailable
Facility
$1811.48
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 19368
Office
Unavailable
Facility
$2021.12
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 19368
Office
Unavailable
Facility
$1893.04
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 19368
Office
Unavailable
Facility
$1994.96
No comparable office rate is available.
Rest Of Maryland
Maryland · 19368
Office
Unavailable
Facility
$1887.60
No comparable office rate is available.
Rest Of Maine
Maine · 19368
Office
Unavailable
Facility
$1762.66
No comparable office rate is available.
Southern Maine
Maine · 19368
Office
Unavailable
Facility
$1805.49
No comparable office rate is available.
Detroit
Michigan · 19368
Office
Unavailable
Facility
$2007.20
No comparable office rate is available.
Rest Of Michigan
Michigan · 19368
Office
Unavailable
Facility
$1862.77
No comparable office rate is available.
Minnesota
Minnesota · 19368
Office
Unavailable
Facility
$1758.61
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 19368
Office
Unavailable
Facility
$1846.55
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 19368
Office
Unavailable
Facility
$1859.19
No comparable office rate is available.
Rest Of Missouri
Missouri · 19368
Office
Unavailable
Facility
$1801.49
No comparable office rate is available.
Mississippi
Mississippi · 19368
Office
Unavailable
Facility
$1752.64
No comparable office rate is available.
Montana**
Montana · 19368
Office
Unavailable
Facility
$1886.07
No comparable office rate is available.
North Carolina
North Carolina · 19368
Office
Unavailable
Facility
$1773.66
No comparable office rate is available.
North Dakota**
North Dakota · 19368
Office
Unavailable
Facility
$1764.47
No comparable office rate is available.
Nebraska
Nebraska · 19368
Office
Unavailable
Facility
$1714.27
No comparable office rate is available.
New Hampshire
New Hampshire · 19368
Office
Unavailable
Facility
$1884.47
No comparable office rate is available.
Northern Nj
New Jersey · 19368
Office
Unavailable
Facility
$2062.34
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 19368
Office
Unavailable
Facility
$2003.66
No comparable office rate is available.
New Mexico
New Mexico · 19368
Office
Unavailable
Facility
$1879.87
No comparable office rate is available.
Nevada**
Nevada · 19368
Office
Unavailable
Facility
$1852.76
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 19368
Office
Unavailable
Facility
$2242.26
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 19368
Office
Unavailable
Facility
$2034.13
No comparable office rate is available.
Queens
New York · 19368
Office
Unavailable
Facility
$2152.97
No comparable office rate is available.
Rest Of New York
New York · 19368
Office
Unavailable
Facility
$1796.62
No comparable office rate is available.
Ohio
Ohio · 19368
Office
Unavailable
Facility
$1837.91
No comparable office rate is available.
Oklahoma
Oklahoma · 19368
Office
Unavailable
Facility
$1778.92
No comparable office rate is available.
Portland
Oregon · 19368
Office
Unavailable
Facility
$1915.62
No comparable office rate is available.
Rest Of Oregon
Oregon · 19368
Office
Unavailable
Facility
$1823.17
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 19368
Office
Unavailable
Facility
$1969.66
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 19368
Office
Unavailable
Facility
$1827.86
No comparable office rate is available.
Puerto Rico
Puerto Rico · 19368
Office
Unavailable
Facility
$1889.75
No comparable office rate is available.
Rhode Island
Rhode Island · 19368
Office
Unavailable
Facility
$1904.32
No comparable office rate is available.
South Carolina
South Carolina · 19368
Office
Unavailable
Facility
$1811.81
No comparable office rate is available.
South Dakota**
South Dakota · 19368
Office
Unavailable
Facility
$1750.09
No comparable office rate is available.
Tennessee
Tennessee · 19368
Office
Unavailable
Facility
$1738.85
No comparable office rate is available.
Austin
Texas · 19368
Office
Unavailable
Facility
$1898.75
No comparable office rate is available.
Beaumont
Texas · 19368
Office
Unavailable
Facility
$1819.95
No comparable office rate is available.
Brazoria
Texas · 19368
Office
Unavailable
Facility
$1844.93
No comparable office rate is available.
Dallas
Texas · 19368
Office
Unavailable
Facility
$1864.94
No comparable office rate is available.
Fort Worth
Texas · 19368
Office
Unavailable
Facility
$1861.84
No comparable office rate is available.
Galveston
Texas · 19368
Office
Unavailable
Facility
$1855.94
No comparable office rate is available.
Houston
Texas · 19368
Office
Unavailable
Facility
$1968.51
No comparable office rate is available.
Rest Of Texas
Texas · 19368
Office
Unavailable
Facility
$1837.12
No comparable office rate is available.
Utah
Utah · 19368
Office
Unavailable
Facility
$1830.90
No comparable office rate is available.
Virginia
Virginia · 19368
Office
Unavailable
Facility
$1816.28
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 19368
Office
Unavailable
Facility
$1889.75
No comparable office rate is available.
Vermont
Vermont · 19368
Office
Unavailable
Facility
$1779.24
No comparable office rate is available.
Rest Of Washington
Washington · 19368
Office
Unavailable
Facility
$1882.33
No comparable office rate is available.
Seattle (King Cnty)
Washington · 19368
Office
Unavailable
Facility
$2035.10
No comparable office rate is available.
Wisconsin
Wisconsin · 19368
Office
Unavailable
Facility
$1720.09
No comparable office rate is available.
West Virginia
West Virginia · 19368
Office
Unavailable
Facility
$1899.41
No comparable office rate is available.
Wyoming**
Wyoming · 19368
Office
Unavailable
Facility
$1833.07
No comparable office rate is available.
See how rates vary across the country
19368 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 19368 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$2050.76
$1864.33 × 110% = $2050.76
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 19368 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,705
- Code
- 19368
- Physician work
- 33.05
- Practice expense
- 17.28
- Malpractice
- 6.15
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 33.05 | × 1.005 | 33.2152 |
| Practice expense | 17.28 | × 0.988 | 17.0726 |
| Malpractice | 6.15 | × 0.899 | 5.5289 |
| Total RVUs | 55.8167 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1864.33
Open 19368 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 33.05 | 1.005 |
| Practice expense | 17.28 | 0.988 |
| Malpractice | 6.15 | 0.899 |
(33.05 × 1.005 + 17.28 × 0.988 + 6.15 × 0.899) × $33.4009 = $1864.33
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
19368 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1864.33 | RVU26D |
| 2026-07-01 | Not available in this setting | $1864.33 | RVU26C |
| 2026-04-01 | Not available in this setting | $1864.33 | RVU26B |
| 2026-01-01 | Not available in this setting | $1864.33 | RVU26A |
| 2025-10-01 | Not available in this setting | $2106.63 | RVU25D |
| 2025-07-01 | Not available in this setting | $2106.63 | RVU25C |
| 2025-04-01 | Not available in this setting | $2106.63 | RVU25B |
| 2025-01-01 | Not available in this setting | $2106.63 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,70219361,,Brst rcnstj latsms drsi flap,A,,22.78,14.31,NA,14.31,,4.29,41.38,41.38,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70319364,,Brst rcnstj free flap,A,,41.52,21.49,NA,21.49,,7.93,70.94,70.94,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70419367,,Brst rcnstj 1 pdcl tram flap,A,,26.13,15.70,NA,15.70,,4.85,46.68,46.68,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70519368,,Brst rcnstj 1pdcl tram anast,A,,33.05,17.28,NA,17.28,,6.15,56.48,56.48,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70619369,,Brst rcnstj 2 pdcl tram flap,A,,30.53,16.36,NA,16.36,,5.68,52.57,52.57,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70719370,,Revj peri-implt capsule brst,A,,8.94,7.82,NA,7.82,,1.68,18.44,18.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70819371,,Peri-implt capslc brst compl,A,,9.73,7.87,NA,7.87,,1.84,19.44,19.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503