No office rate
Use 19396 for custom design and manufacture of a patient-specific implant. Use 19325 for breast augmentation with an implant.
On this page
CMS RVU26D · Effective 2026-10-01
19396 Custom implant Medicare reimbursement rates in Hawaii
Report custom breast implant design and manufacture for a patient-specific implant; use a separate applicable code when the implant is surgically placed. Compare 19396 office and facility rates across CMS payment localities in Hawaii.
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 19396 in Hawaii?
Hawaii 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
$314.57
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$126.58
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 19396: Custom breast implant design and manufacture
Report custom breast implant design and manufacture for a patient-specific implant; use a separate applicable code when the implant is surgically placed.
This service covers designing and manufacturing a breast implant tailored to a patient’s anatomy rather than selecting a standard implant. Plastic surgeons involved in breast reconstruction or augmentation may coordinate the custom design with the manufacturer, using patient-specific measurements or imaging to address an unusual contour or fit. The work concerns the custom implant itself, not its surgical placement.
Report 19396 when the record supports actual custom design and manufacture; document the patient-specific features and the work performed. Report the applicable implant-placement service separately when placement is performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral reporting with modifier 50, CMS pays at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 19396
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.12 · 24%
- Practice expense (office) RVU6.22 · 71%
- Malpractice RVU0.39 · 4%
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.
19396 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
19340 describes implant placement in the setting of immediate reconstruction. It does not represent custom design and manufacture.
No office rate
19342 describes delayed implant placement or replacement in reconstruction. It is distinct from designing and manufacturing a custom implant.
Compare 19396 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
Hawaii, Guam →
Office / nonfacility
$314.57
Facility
$126.58
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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 19396 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,710
- Code
- 19396
- Physician work
- 2.12
- Practice expense
- 6.22
- Malpractice
- 0.39
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.12 | × 1.000 | 2.1200 |
| Practice expense | 6.22 | × 1.137 | 7.0721 |
| Malpractice | 0.39 | × 0.579 | 0.2258 |
| Total RVUs | 9.4179 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$314.57
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.12 | 1 |
| Practice expense | 6.22 | 1.137 |
| Malpractice | 0.39 | 0.579 |
(2.12 × 1 + 6.22 × 1.137 + 0.39 × 0.579) × $33.4009 = $314.57
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.12 | 1 |
| Practice expense | 1.27 | 1.137 |
| Malpractice | 0.39 | 0.579 |
(2.12 × 1 + 1.27 × 1.137 + 0.39 × 0.579) × $33.4009 = $126.58
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.
19396 billing questions
How is 19396 different from implant placement?
19396 represents custom implant design and manufacture, not the operation to place the implant. Report the applicable placement code when placement is performed.
When should 19396 be chosen over 19325?
Use 19396 for patient-specific design and manufacture of a custom implant. Code 19325 describes breast augmentation with an implant, rather than the custom-design work.
Can an implant placement code be reported with 19396?
Yes, when the custom implant is also surgically placed and the documentation supports the placement service. The design and manufacture and the operative placement describe distinct work.
What documentation supports 19396?
Document why a custom implant was needed, its patient-specific design features, and the design and manufacturing work performed. A record that only identifies selection or placement of a standard implant does not establish this service.
How should bilateral custom implant work be reported?
For a bilateral procedure reported with modifier 50, CMS pays at 150%. The record should support custom design and manufacture for both sides.
How do multiple-procedure and assistant rules affect payment?
In a same-session multiple-procedure situation, CMS pays the highest-valued procedure in full and the others at 50%. Assistant-at-surgery payment requires documented medical necessity; 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 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.
1,70719370,,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
1,71119499,,Unlisted procedure breast,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7122000F,,Blood pressure measure,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7132001F,,Weight record,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014