Billing code 19370: Capsule revisionMedicare rate & RVUs in Illinois
Reports surgical release or partial removal of the fibrous capsule around a breast implant, commonly performed to address capsular contracture or implant distortion.
CMS doesn’t publish an office rate for 19370 in Illinois.
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 19370 covers
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.
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 19370 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $691.98 |
| East St. Louis | Unavailable | $651.92 |
| Rest Of Illinois | Unavailable | $624.78 |
| Suburban Chicago | Unavailable | $668.37 |
How the 19370 rate is calculated
Each of 19370’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 · 19370
RVUs × geographic indexes × conversion factor
Work8.94
8.94 RVUs× 1.000 GPCI
Practice expense7.82
7.82 RVUs× 1.000 GPCI
Malpractice1.68
1.68 RVUs× 1.000 GPCI
Adjusted RVUs
18.4400
Conversion factor
$33.4009
Medicare rate
$615.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19370
19370 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19370
Capsule revision
| 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 · 19370
Capsule revision
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
19370 without 50 · national facility
$615.91
Capsule revision
19370-50 · Bilateral: 150%
$923.87
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).
19370 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19371Capsulectomy
- 19370 represents capsule release or partial removal; 19371 is for complete capsule removal.
- 19342Breast implant
- 19342 describes delayed placement or replacement of an implant. Use 19370 for capsule revision, not implant exchange by itself.
- 19328Implant removal
- 19328 describes removal of an intact implant. It does not represent capsule release or partial capsule removal.
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 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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