CPT code 19350: Nipple reconstruction2026 Medicare rate & RVUs in Florida
Reports surgical reconstruction of the nipple and areola, commonly as a later stage of breast reconstruction after mastectomy.
Medicare pays $898.04–$1,001.29 for 19350 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 19350 covers
This service recreates the nipple and areola, most often after mastectomy and reconstruction of the breast mound. A plastic surgeon or other surgeon experienced in breast reconstruction may use local tissue rearrangement to create nipple projection and grafting or other reconstructive techniques for the areola. It is commonly performed in an outpatient or hospital setting as a later stage of reconstruction.
Report 19350 for the nipple-and-areola reconstruction itself, not for correction of an inverted nipple or a broader revision of the reconstructed breast. The operative note should describe the reconstructed anatomy and work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure 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 19350 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$898.04 to $1001.29
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $945.92 | $664.41 |
| Miami | $1,001.29 | $712.00 |
| Rest Of Florida | $898.04 | $632.37 |
How the 19350 rate is calculated
Each of 19350’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 · 19350
RVUs × geographic indexes × conversion factor
Work8.88
8.88 RVUs× 1.000 GPCI
Practice expense16.21
16.21 RVUs× 1.000 GPCI
Malpractice1.67
1.67 RVUs× 1.000 GPCI
Adjusted RVUs
26.7600
Conversion factor
$33.4009
Medicare rate
$893.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19350
19350 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19350
Nipple reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19350
Nipple reconstruction
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19350 without 50 · national office
$893.81
Nipple reconstruction
19350-50 · Bilateral: 150%
$1,340.72
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).
19350 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19355Nipple correction
- Choose 19355 for an inverted nipple; choose 19350 when reconstructing the nipple and areola, commonly after mastectomy.
- 19380Breast revision
- 19380 covers revision of a reconstructed breast. 19350 is specific to nipple-and-areola reconstruction.
- 19357Breast reconstruction
- 19357 describes tissue-expander placement for breast reconstruction; 19350 addresses reconstruction of the nipple and areola.
19350 billing questions
How is 19350 different from 19355?
19350 is for reconstructing the nipple and areola, usually after mastectomy. 19355 addresses an inverted nipple rather than creating a nipple–areola complex.
When should a broader breast revision be reported instead?
Use 19380 when the documented work revises the reconstructed breast more broadly, such as its contour or overall reconstruction. Use 19350 for nipple-and-areola reconstruction.
Does 19350 include the breast mound reconstruction?
No. It describes nipple-and-areola reconstruction; breast mound reconstruction is a separate service when performed and supported by the operative documentation.
How should bilateral reconstruction be reported?
CMS identifies 19350 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 related postoperative care. The operative note should support the reconstructive work and the postoperative record should reflect care related to that surgery.
Can an assistant or co-surgeon be paid for this procedure?
CMS applies a statutory restriction on assistant-at-surgery payment for 19350. 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
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