Billing code 19364: Free-flap reconstructionMedicare rate & RVUs in Florida
Reports breast reconstruction using a free flap of the patient’s own tissue, transferred to the chest and connected through microsurgical vessel anastomoses.
CMS doesn’t publish an office rate for 19364 in Florida.
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 19364 covers
Code 19364 represents autologous breast reconstruction using tissue detached from a donor site and transferred to the chest, with its blood vessels connected microsurgically. Plastic and reconstructive surgeons commonly use abdominal perforator tissue, such as a DIEP flap; selected cases use tissue from the thigh or buttock. Reconstruction may be performed during mastectomy or later, typically in a hospital operating room.
Report the service for the free-flap reconstruction, not for a pedicled flap that remains attached to its original blood supply. The operative report should identify the flap and donor site, document the transfer and vascular connections, and specify the reconstructed side. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. For same-session 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 available; co-surgeons require supporting documentation, and team surgery is 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 19364 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.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $2,592.81 |
| Miami | Unavailable | $2,803.87 |
| Rest Of Florida | Unavailable | $2,471.11 |
How the 19364 rate is calculated
Each of 19364’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 · 19364
RVUs × geographic indexes × conversion factor
Work41.52
41.52 RVUs× 1.000 GPCI
Practice expense21.49
21.49 RVUs× 1.000 GPCI
Malpractice7.93
7.93 RVUs× 1.000 GPCI
Adjusted RVUs
70.9400
Conversion factor
$33.4009
Medicare rate
$2,369.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19364
19364 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19364
Free-flap 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 19364
Free-flap 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
19364 without 50 · national facility
$2,369.46
Free-flap reconstruction
19364-50 · Bilateral: 150%
$3,554.19
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).
19364 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 19361Breast reconstruction
- Use 19361 for reconstruction with a pedicled latissimus dorsi flap. Code 19364 describes transfer of free tissue with microsurgical vascular connections.
- 19367Breast reconstruction
- Code 19367 describes a single-pedicle TRAM flap without microvascular anastomosis; 19364 is for free-flap transfer.
- 19368TRAM reconstruction
- Code 19368 is specific to a single-pedicle TRAM reconstruction with microvascular anastomosis. Select 19364 when the documented free flap is not reported under that specific TRAM code.
- 19357Breast reconstruction
- Code 19357 reports placement of a tissue expander, commonly as a staged implant-based approach; 19364 reports reconstruction with transferred autologous free tissue.
19364 billing questions
How does 19364 differ from a pedicled TRAM flap?
Code 19364 is for tissue completely detached and transferred as a free flap, with microsurgical vessel connections. A pedicled TRAM flap remains attached to its original blood supply and is reported using the applicable TRAM code.
Can 19364 be reported with a mastectomy?
Yes. Immediate free-flap reconstruction may be performed in the same session as a mastectomy, with each service reported when supported by the operative documentation.
How is bilateral free-flap reconstruction reported?
When reconstruction is performed on both breasts, report the bilateral procedure with modifier 50. CMS payment for the bilateral procedure is 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care. Routine follow-up for the reconstruction during that period is part of the global service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons are paid only when supporting documentation is provided; 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 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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