No office rate
19370 represents capsule release or partial removal; 19371 is for complete capsule removal.
On this page
CMS RVU26D · Effective 2026-10-01
19370 Capsule revision Medicare reimbursement rates in Alabama
Reports surgical release or partial removal of the fibrous capsule around a breast implant, commonly performed to address capsular contracture or implant distortion. Compare 19370 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 19370 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$558.91
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Breast surgery
About 19370: Breast implant capsule revision
Reports surgical release or partial removal of the fibrous capsule around a breast implant, commonly performed to address capsular contracture or implant distortion.
A surgeon revises the scar-like tissue surrounding a breast implant by releasing it or removing part of it. This work is commonly performed for capsular contracture that makes the breast firm, painful, or distorted. Plastic surgeons and breast surgeons typically perform the procedure in an operating room, often during surgery that also addresses the implant itself. The capsule work is distinct from implant removal or replacement alone.
Select this code when the operative record supports revision of the capsule, such as release of a tight capsule or partial excision; complete capsule removal points to 19371. Document the affected side, the capsule work performed, the clinical problem, and any separate implant procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 19370
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.94 · 48%
- Practice expense (office) RVU7.82 · 42%
- Malpractice RVU1.68 · 9%
2.7K
Medicare services in 2024 · #2242 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.
19370 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
19342 describes delayed placement or replacement of an implant. Use 19370 for capsule revision, not implant exchange by itself.
No office rate
19328 describes removal of an intact implant. It does not represent capsule release or partial capsule removal.
Compare 19370 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$558.91
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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 19370 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,707
- Code
- 19370
- Physician work
- 8.94
- Practice expense
- 7.82
- Malpractice
- 1.68
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.94 | × 1.000 | 8.9400 |
| Practice expense | 7.82 | × 0.875 | 6.8425 |
| Malpractice | 1.68 | × 0.566 | 0.9509 |
| Total RVUs | 16.7334 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$558.91
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.94 | 1 |
| Practice expense | 7.82 | 0.875 |
| Malpractice | 1.68 | 0.566 |
(8.94 × 1 + 7.82 × 0.875 + 1.68 × 0.566) × $33.4009 = $558.91
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.
19370 billing questions
When should 19371 be used instead?
Use 19370 for capsule release or partial capsule removal. When the surgeon removes the capsule completely, report 19371.
Can implant replacement be reported with capsule revision?
When the surgeon also replaces the implant, 19342 may describe that separate work. The operative note should clearly document both the implant procedure and the capsule revision.
Does implant removal alone support 19370?
No. Removal of an intact implant is described by 19328, and removal of a ruptured implant by 19330; 19370 represents capsule revision, not removal alone.
How is bilateral capsule revision reported?
For bilateral surgery, use modifier 50; CMS pays this code at 150% under the stated bilateral rule.
Can an assistant surgeon be paid for 19370?
CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.
What postoperative care is included in the global period?
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.
1,70419367,,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
1,70919380,,Revj reconstructed breast,A,,10.89,9.09,NA,9.09,,2.05,22.03,22.03,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71019396,,Design custom breast implant,A,,2.12,6.22,,1.27,,0.39,8.73,3.78,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515