$821.10
19355 corrects inversion of an existing nipple. 19350 addresses nipple or areola reconstruction, such as when the nipple is absent.
On this page
CMS RVU26D · Effective 2026-10-01
19355 Nipple correction Medicare reimbursement rates in Idaho
Corrects an inverted nipple by surgery when eversion is the operative goal, rather than reconstruction of a missing nipple or broader breast surgery. Compare 19355 office and facility rates across CMS payment localities in Idaho.
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 19355 in Idaho?
Idaho 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
$748.22
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$516.53
1 of 1 localities have a supported rate.
Payment area: Idaho
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 19355: Surgical correction of inverted nipple
Corrects an inverted nipple by surgery when eversion is the operative goal, rather than reconstruction of a missing nipple or broader breast surgery.
This operation corrects an existing nipple that turns inward. A breast or plastic surgeon typically performs it in an operating-room setting, often for persistent inversion associated with symptoms or functional concerns. The operative goal is to evert the nipple, not to create a nipple after mastectomy or to reshape the breast. The technique varies, so the operative report should establish the condition treated and the correction performed.
Report 19355 for the nipple-correction service, identifying the treated side and using modifier 50 when performed bilaterally under the CMS bilateral rule. The record should document the inversion, laterality, operative work, and any separate breast procedure performed in the same session. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 19355
- 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 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 RVU8.31 · 34%
- Practice expense (office) RVU14.53 · 60%
- Malpractice RVU1.53 · 6%
37
Medicare services in 2024 · #5535 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.
19355 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
19316 is a breast lift for ptosis. It is not the code for an operation whose goal is correction of nipple inversion.
No office rate
19318 addresses breast reduction. Choose 19355 when the operative target is an inverted nipple, not breast size.
Compare 19355 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
Idaho →
Office / nonfacility
$748.22
Facility
$516.53
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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 19355 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,700
- Code
- 19355
- Physician work
- 8.31
- Practice expense
- 14.53
- Malpractice
- 1.53
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.31 | × 1.000 | 8.3100 |
| Practice expense | 14.53 | × 0.920 | 13.3676 |
| Malpractice | 1.53 | × 0.473 | 0.7237 |
| Total RVUs | 22.4013 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$748.22
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.31 | 1 |
| Practice expense | 14.53 | 0.92 |
| Malpractice | 1.53 | 0.473 |
(8.31 × 1 + 14.53 × 0.92 + 1.53 × 0.473) × $33.4009 = $748.22
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.31 | 1 |
| Practice expense | 6.99 | 0.92 |
| Malpractice | 1.53 | 0.473 |
(8.31 × 1 + 6.99 × 0.92 + 1.53 × 0.473) × $33.4009 = $516.53
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.
19355 billing questions
When should 19355 be chosen over 19350?
Use 19355 to correct an existing inverted nipple. Code 19350 concerns nipple or areola reconstruction, such as reconstruction when the nipple is absent.
How is bilateral correction reported?
For correction on both sides, report modifier 50 under the CMS bilateral rule. The CMS payment rule for this code is 150% for a bilateral procedure with modifier 50.
What documentation supports 19355?
Document the nipple inversion, side treated, the operative correction, and whether one or both nipples were treated. Include the operative goal when another breast procedure is performed in the same session.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.
How does payment work when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
1,69719340,,Insj breast implt sm d mast,A,,10.22,8.76,NA,8.76,,2.01,20.99,20.99,0,090,0.10,0.71,0.19,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69819342,,Insj/rplcmt brst implt sep d,A,,10.22,8.66,NA,8.66,,1.91,20.79,20.79,0,090,0.10,0.71,0.19,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69919350,,Nipple/areola reconstruction,A,,8.88,16.21,,7.89,,1.67,26.76,18.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70019355,,Correct inverted nipple(s),A,,8.31,14.53,,6.99,,1.53,24.37,16.83,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70119357,,Tiss xpndr plmt brst rcnstj,A,,14.47,14.93,NA,14.93,,2.72,32.12,32.12,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70219361,,Brst rcnstj latsms drsi flap,A,,22.78,14.31,NA,14.31,,4.29,41.38,41.38,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70319364,,Brst rcnstj free flap,A,,41.52,21.49,NA,21.49,,7.93,70.94,70.94,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772