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CMS RVU26D · Effective 2026-10-01

19367 in Manhattan

Office / nonfacility

Not available in this setting

Base rate per service

Facility setting

$1794.89

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 19367: Breast reconstruction with single-pedicle TRAM flap

Reports breast reconstruction using an abdominal single-pedicle TRAM flap, typically after mastectomy, when the flap remains attached to its vascular supply.

The surgeon uses skin, fat, and a portion of rectus abdominis muscle from the abdomen to form a breast mound. The flap is tunneled to the chest while remaining connected to its original blood supply; this distinguishes the service from a free flap requiring microvascular reconnection. Plastic surgeons commonly perform this reconstruction after mastectomy in a hospital or other facility setting. The abdominal donor site is also closed as part of the reconstructive operation.

Select this code for the single-pedicle TRAM approach without microvascular anastomosis; a single-pedicle flap with microvascular anastomosis and a two-pedicle flap have separate codes. Document the flap technique, laterality, and reconstructive work. 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 19367

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 RVU26.13 · 56%
  • Practice expense (office) RVU15.70 · 34%
  • Malpractice RVU4.85 · 10%

24

Medicare services in 2024 · #5802 by national volume

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.

19367 compared with similar codes

Office rates for Manhattan, from the same CMS release.

19368

TRAM reconstruction

Single pedicle, microvascular

No office rate

Both use a single-pedicle TRAM flap. Choose 19368 when the flap is transferred with microvascular anastomosis; 19367 is the pedicled approach without that anastomosis.

19369

TRAM flap reconstruction

Two-pedicle technique

No office rate

19369 describes a two-pedicle TRAM flap. For 19367, the reconstruction uses one pedicle.

19364

Free-flap reconstruction

Autologous free tissue

No office rate

19364 is reconstruction with a free flap, which requires microvascular reconnection. In 19367, the TRAM flap remains attached to its original blood supply.

19361

Breast reconstruction

Latissimus dorsi flap

No office rate

19361 uses tissue from the latissimus dorsi in the back; 19367 uses abdominal tissue and rectus muscle.

The same code, a different location

How does Manhattan compare?

19367 across payment areas

Same release and payment basis · bars start at $0

  1. Manhattan · This locality

    Unavailable

  2. No comparable rate is available in this setting.

  3. No comparable rate is available in this setting.

  4. Queens

    Unavailable

    No comparable rate is available in this setting.

  5. Rest Of New York

    Unavailable

    No comparable rate is available in this setting.

  6. No comparable rate is available in this setting.

  7. No comparable rate is available in this setting.

Other payment areas listed in New York 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
  • Miami

    Florida · 19367

    Office

    Unavailable

    Facility

    $1828.34

    No comparable office rate is available.

  • Chicago

    Illinois · 19367

    Office

    Unavailable

    Facility

    $1777.67

    No comparable office rate is available.

  • Alaska*

    Alaska · 19367

    Office

    Unavailable

    Facility

    $1956.89

    No comparable office rate is available.

  • Alabama

    Alabama · 19367

    Office

    Unavailable

    Facility

    $1423.30

    No comparable office rate is available.

  • Arkansas

    Arkansas · 19367

    Office

    Unavailable

    Facility

    $1406.65

    No comparable office rate is available.

  • Arizona

    Arizona · 19367

    Office

    Unavailable

    Facility

    $1519.57

    No comparable office rate is available.

  • Bakersfield

    California · 19367

    Office

    Unavailable

    Facility

    $1562.74

    No comparable office rate is available.

  • Chico

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • El Centro

    California · 19367

    Office

    Unavailable

    Facility

    $1549.98

    No comparable office rate is available.

  • Fresno

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Hanford-Corcoran

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Madera

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Merced

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Modesto

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Napa

    California · 19367

    Office

    Unavailable

    Facility

    $1701.19

    No comparable office rate is available.

  • Oxnard-Thousand Oaks-Ventura

    California · 19367

    Office

    Unavailable

    Facility

    $1617.96

    No comparable office rate is available.

  • Redding

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Rest Of California

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Riverside-San Bernardino-Ontario

    California · 19367

    Office

    Unavailable

    Facility

    $1601.39

    No comparable office rate is available.

  • Sacramento-Roseville-Folsom

    California · 19367

    Office

    Unavailable

    Facility

    $1600.88

    No comparable office rate is available.

  • Salinas

    California · 19367

    Office

    Unavailable

    Facility

    $1594.42

    No comparable office rate is available.

  • San Diego-Chula Vista-Carlsbad

    California · 19367

    Office

    Unavailable

    Facility

    $1613.92

    No comparable office rate is available.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 19367

    Office

    Unavailable

    Facility

    $1769.43

    No comparable office rate is available.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 19367

    Office

    Unavailable

    Facility

    $1763.92

    No comparable office rate is available.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 19367

    Office

    Unavailable

    Facility

    $1811.78

    No comparable office rate is available.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 19367

    Office

    Unavailable

    Facility

    $1789.26

    No comparable office rate is available.

  • San Luis Obispo-Paso Robles

    California · 19367

    Office

    Unavailable

    Facility

    $1571.72

    No comparable office rate is available.

  • Santa Cruz-Watsonville

    California · 19367

    Office

    Unavailable

    Facility

    $1615.06

    No comparable office rate is available.

  • Santa Maria-Santa Barbara

    California · 19367

    Office

    Unavailable

    Facility

    $1595.48

    No comparable office rate is available.

  • Santa Rosa-Petaluma

    California · 19367

    Office

    Unavailable

    Facility

    $1629.73

    No comparable office rate is available.

  • Stockton

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Vallejo

    California · 19367

    Office

    Unavailable

    Facility

    $1693.26

    No comparable office rate is available.

  • Visalia

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Yuba City

    California · 19367

    Office

    Unavailable

    Facility

    $1549.17

    No comparable office rate is available.

  • Colorado

    Colorado · 19367

    Office

    Unavailable

    Facility

    $1567.71

    No comparable office rate is available.

  • Connecticut

    Connecticut · 19367

    Office

    Unavailable

    Facility

    $1651.01

    No comparable office rate is available.

  • Delaware

    Delaware · 19367

    Office

    Unavailable

    Facility

    $1540.86

    No comparable office rate is available.

  • Fort Lauderdale

    Florida · 19367

    Office

    Unavailable

    Facility

    $1696.86

    No comparable office rate is available.

  • Rest Of Florida

    Florida · 19367

    Office

    Unavailable

    Facility

    $1617.56

    No comparable office rate is available.

  • Atlanta

    Georgia · 19367

    Office

    Unavailable

    Facility

    $1602.72

    No comparable office rate is available.

  • Rest Of Georgia

    Georgia · 19367

    Office

    Unavailable

    Facility

    $1533.62

    No comparable office rate is available.

  • Hawaii, Guam

    Hawaii · 19367

    Office

    Unavailable

    Facility

    $1562.80

    No comparable office rate is available.

  • Iowa

    Iowa · 19367

    Office

    Unavailable

    Facility

    $1416.90

    No comparable office rate is available.

  • Idaho

    Idaho · 19367

    Office

    Unavailable

    Facility

    $1431.83

    No comparable office rate is available.

  • East St. Louis

    Illinois · 19367

    Office

    Unavailable

    Facility

    $1681.46

    No comparable office rate is available.

  • Rest Of Illinois

    Illinois · 19367

    Office

    Unavailable

    Facility

    $1604.73

    No comparable office rate is available.

  • Suburban Chicago

    Illinois · 19367

    Office

    Unavailable

    Facility

    $1704.48

    No comparable office rate is available.

  • Indiana

    Indiana · 19367

    Office

    Unavailable

    Facility

    $1437.61

    No comparable office rate is available.

  • Kansas

    Kansas · 19367

    Office

    Unavailable

    Facility

    $1428.46

    No comparable office rate is available.

  • Kentucky

    Kentucky · 19367

    Office

    Unavailable

    Facility

    $1487.18

    No comparable office rate is available.

  • New Orleans

    Louisiana · 19367

    Office

    Unavailable

    Facility

    $1550.25

    No comparable office rate is available.

  • Rest Of Louisiana

    Louisiana · 19367

    Office

    Unavailable

    Facility

    $1492.04

    No comparable office rate is available.

  • Metropolitan Boston

    Massachusetts · 19367

    Office

    Unavailable

    Facility

    $1678.85

    No comparable office rate is available.

  • Rest Of Massachusetts

    Massachusetts · 19367

    Office

    Unavailable

    Facility

    $1568.03

    No comparable office rate is available.

  • Baltimore/Surr. Cntys

    Maryland · 19367

    Office

    Unavailable

    Facility

    $1649.79

    No comparable office rate is available.

  • Rest Of Maryland

    Maryland · 19367

    Office

    Unavailable

    Facility

    $1560.89

    No comparable office rate is available.

  • Rest Of Maine

    Maine · 19367

    Office

    Unavailable

    Facility

    $1455.97

    No comparable office rate is available.

  • Southern Maine

    Maine · 19367

    Office

    Unavailable

    Facility

    $1494.66

    No comparable office rate is available.

  • Detroit

    Michigan · 19367

    Office

    Unavailable

    Facility

    $1651.93

    No comparable office rate is available.

  • Rest Of Michigan

    Michigan · 19367

    Office

    Unavailable

    Facility

    $1534.43

    No comparable office rate is available.

  • Minnesota

    Minnesota · 19367

    Office

    Unavailable

    Facility

    $1460.32

    No comparable office rate is available.

  • Metropolitan Kansas City

    Missouri · 19367

    Office

    Unavailable

    Facility

    $1523.44

    No comparable office rate is available.

  • Metropolitan St. Louis

    Missouri · 19367

    Office

    Unavailable

    Facility

    $1534.31

    No comparable office rate is available.

  • Rest Of Missouri

    Missouri · 19367

    Office

    Unavailable

    Facility

    $1482.58

    No comparable office rate is available.

  • Mississippi

    Mississippi · 19367

    Office

    Unavailable

    Facility

    $1443.98

    No comparable office rate is available.

  • Montana**

    Montana · 19367

    Office

    Unavailable

    Facility

    $1558.83

    No comparable office rate is available.

  • North Carolina

    North Carolina · 19367

    Office

    Unavailable

    Facility

    $1465.54

    No comparable office rate is available.

  • North Dakota**

    North Dakota · 19367

    Office

    Unavailable

    Facility

    $1462.93

    No comparable office rate is available.

  • Nebraska

    Nebraska · 19367

    Office

    Unavailable

    Facility

    $1418.02

    No comparable office rate is available.

  • New Hampshire

    New Hampshire · 19367

    Office

    Unavailable

    Facility

    $1560.40

    No comparable office rate is available.

  • Northern Nj

    New Jersey · 19367

    Office

    Unavailable

    Facility

    $1709.06

    No comparable office rate is available.

  • Rest Of New Jersey

    New Jersey · 19367

    Office

    Unavailable

    Facility

    $1658.02

    No comparable office rate is available.

  • New Mexico

    New Mexico · 19367

    Office

    Unavailable

    Facility

    $1548.19

    No comparable office rate is available.

  • Nevada**

    Nevada · 19367

    Office

    Unavailable

    Facility

    $1532.63

    No comparable office rate is available.

  • Ohio

    Ohio · 19367

    Office

    Unavailable

    Facility

    $1514.83

    No comparable office rate is available.

  • Oklahoma

    Oklahoma · 19367

    Office

    Unavailable

    Facility

    $1466.92

    No comparable office rate is available.

  • Portland

    Oregon · 19367

    Office

    Unavailable

    Facility

    $1589.86

    No comparable office rate is available.

  • Rest Of Oregon

    Oregon · 19367

    Office

    Unavailable

    Facility

    $1508.94

    No comparable office rate is available.

  • Metropolitan Philadelphia

    Pennsylvania · 19367

    Office

    Unavailable

    Facility

    $1627.63

    No comparable office rate is available.

  • Rest Of Pennsylvania

    Pennsylvania · 19367

    Office

    Unavailable

    Facility

    $1507.24

    No comparable office rate is available.

  • Puerto Rico

    Puerto Rico · 19367

    Office

    Unavailable

    Facility

    $1562.49

    No comparable office rate is available.

  • Rhode Island

    Rhode Island · 19367

    Office

    Unavailable

    Facility

    $1575.55

    No comparable office rate is available.

  • South Carolina

    South Carolina · 19367

    Office

    Unavailable

    Facility

    $1495.00

    No comparable office rate is available.

  • South Dakota**

    South Dakota · 19367

    Office

    Unavailable

    Facility

    $1451.59

    No comparable office rate is available.

  • Tennessee

    Tennessee · 19367

    Office

    Unavailable

    Facility

    $1436.43

    No comparable office rate is available.

  • Austin

    Texas · 19367

    Office

    Unavailable

    Facility

    $1572.85

    No comparable office rate is available.

  • Beaumont

    Texas · 19367

    Office

    Unavailable

    Facility

    $1500.46

    No comparable office rate is available.

  • Brazoria

    Texas · 19367

    Office

    Unavailable

    Facility

    $1525.78

    No comparable office rate is available.

  • Dallas

    Texas · 19367

    Office

    Unavailable

    Facility

    $1541.91

    No comparable office rate is available.

  • Fort Worth

    Texas · 19367

    Office

    Unavailable

    Facility

    $1538.77

    No comparable office rate is available.

  • Galveston

    Texas · 19367

    Office

    Unavailable

    Facility

    $1534.60

    No comparable office rate is available.

  • Houston

    Texas · 19367

    Office

    Unavailable

    Facility

    $1623.38

    No comparable office rate is available.

  • Rest Of Texas

    Texas · 19367

    Office

    Unavailable

    Facility

    $1516.70

    No comparable office rate is available.

  • Utah

    Utah · 19367

    Office

    Unavailable

    Facility

    $1511.17

    No comparable office rate is available.

  • Virginia

    Virginia · 19367

    Office

    Unavailable

    Facility

    $1502.61

    No comparable office rate is available.

  • Virgin Islands

    United States Virgin Islands · 19367

    Office

    Unavailable

    Facility

    $1562.49

    No comparable office rate is available.

  • Vermont

    Vermont · 19367

    Office

    Unavailable

    Facility

    $1473.88

    No comparable office rate is available.

  • Rest Of Washington

    Washington · 19367

    Office

    Unavailable

    Facility

    $1559.58

    No comparable office rate is available.

  • Seattle (King Cnty)

    Washington · 19367

    Office

    Unavailable

    Facility

    $1692.18

    No comparable office rate is available.

  • Wisconsin

    Wisconsin · 19367

    Office

    Unavailable

    Facility

    $1425.03

    No comparable office rate is available.

  • West Virginia

    West Virginia · 19367

    Office

    Unavailable

    Facility

    $1560.28

    No comparable office rate is available.

  • Wyoming**

    Wyoming · 19367

    Office

    Unavailable

    Facility

    $1517.04

    No comparable office rate is available.

See how rates vary across the country

19367 · 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 / territoryRate 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

Explore 19367 on the national rate map →

Where does this rate apply?

Manhattan is a Medicare payment area. Our Census mapping connects it to 1 cities and communities in New York, 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 19367 in Manhattan. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$1974.38

$1794.89 × 110% = $1974.38

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.

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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 19367 in Manhattan.

PPRRVU2026_Oct_nonQPP.csv

1,704

Code
19367
Physician work
26.13
Practice expense
15.70
Malpractice
4.85

GPCI2026.csv

78

Locality
Manhattan
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Facility calculation for 19367 in Manhattan
ComponentRVULocality factorAdjusted
Physician work26.13× 1.06427.8023
Practice expense15.70× 1.16218.2434
Malpractice4.85× 1.5867.6921
Total RVUs53.7378
Conversion factor× 33.4009

Facility rate, Manhattan$1794.89

Open 19367 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work26.131.064
Practice expense15.71.162
Malpractice4.851.586

(26.13 × 1.064 + 15.7 × 1.162 + 4.85 × 1.586) × $33.4009 = $1794.89

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

19367 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

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 fromOffice / nonfacilityFacilityCMS release
2026-10-01Not available in this setting$1794.89RVU26D
2026-07-01Not available in this setting$1794.89RVU26C
2026-04-01Not available in this setting$1794.89RVU26B
2026-01-01Not available in this setting$1794.89RVU26A
2025-10-01Not available in this setting$2007.32RVU25D
2025-07-01Not available in this setting$2007.32RVU25C
2025-04-01Not available in this setting$2007.32RVU25B
2025-01-01Not available in this setting$2007.32RVU25A

19367 billing questions

How is 19367 distinguished from 19368?

19367 describes a single-pedicle TRAM flap that remains connected to its blood supply. Use 19368 when the single-pedicle flap involves microvascular anastomosis.

When is 19369 used instead?

19369 is for breast reconstruction using a two-pedicle TRAM flap. The number of pedicles used, rather than the size of the reconstruction, distinguishes it from 19367.

Can the mastectomy be reported in the same session?

The mastectomy and the TRAM-flap reconstruction are distinct services and may be reported for the same session when both are performed. For same-session procedures, CMS applies the standard multiple procedure reduction.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. The operative record should identify the flap method and laterality.

How is bilateral reconstruction handled?

CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%. Document the reconstruction performed on each side.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation; team surgery is 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 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.

RVUs for 19367PPRRVU2026_Oct_nonQPP.csv, line 1,704 (RVU26D)
Geographic factors for ManhattanGPCI2026.csv, line 78 (RVU26D)