No office rate
Use reduction mammoplasty when breast volume is reduced through tissue removal and reshaping. Mastopexy focuses on lifting and reshaping without the same volume-reduction objective.
On this page
CMS RVU26D · Effective 2026-10-01
19318 Breast reduction Medicare reimbursement rates in Maine
Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume. Compare 19318 office and facility rates across CMS payment localities in Maine.
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 19318 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$914.19–$940.60
2 of 2 localities have a supported rate.
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.
Plastic surgery
About 19318: Reduction mammoplasty
Breast reduction removes breast tissue and skin and reshapes the breast, commonly to treat symptoms associated with excessive breast volume.
This operation reduces breast volume by removing tissue and skin and reshaping the remaining breast. It is commonly performed for symptomatic macromastia, such as breast-related neck, back, or shoulder discomfort, shoulder grooving, or recurrent skin irritation. A plastic surgeon or another surgeon with breast surgery expertise typically performs the procedure in a hospital or ambulatory surgery setting. The operative report should describe the tissue removal, reshaping, laterality, and clinical rationale.
Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies a 50% reduction to the others. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19318
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.63 · 53%
- Practice expense (office) RVU10.76 · 37%
- Malpractice RVU2.96 · 10%
6.7K
Medicare services in 2024 · #1687 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.
19318 compared with similar codes
Office rates for Maine, from the same CMS release.
$588.10–$618.56
This code is for breast reduction, commonly for symptomatic macromastia. Code 19300 describes surgical treatment of gynecomastia.
No office rate
Reduction mammoplasty removes breast volume; code 19325 is used for breast augmentation with an implant.
No office rate
Reduction mammoplasty addresses breast volume and contour. Code 19301 is used for partial removal of the breast, such as for a breast lesion.
Compare 19318 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$914.19
Southern Maine →
Office / nonfacility
Unavailable
Facility
$940.60
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19318 billing questions
How is breast reduction different from mastopexy?
Reduction mammoplasty removes breast tissue and reduces volume while reshaping the breast. Mastopexy (19316) lifts and reshapes the breast without the same volume-reduction purpose.
How should bilateral breast reduction be reported?
Report modifier 50 for bilateral surgery. CMS pays the bilateral procedure at 150%.
Does the 90-day global period include routine postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
CMS permits payment for an assistant at surgery. Co-surgeon payment requires supporting documentation.
How does CMS handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and the other procedure or procedures are subject to the standard multiple procedure reduction.
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.
1,69019306,,Mast rad urban type,A,,17.68,12.83,NA,12.83,,4.73,35.24,35.24,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69119307,,Mast mod rad,A,,17.54,11.66,NA,11.66,,4.53,33.73,33.73,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69219316,,Mastopexy,A,,10.81,8.89,NA,8.89,,2.13,21.83,21.83,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69319318,,Breast reduction,A,,15.63,10.76,NA,10.76,,2.96,29.35,29.35,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69419325,,Breast augmentation w/implt,A,,7.92,7.55,NA,7.55,,1.48,16.95,16.95,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69519328,,Rmvl intact breast implant,A,,7.25,6.72,NA,6.72,,1.40,15.37,15.37,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69619330,,Rmvl ruptured breast implant,A,,8.78,7.27,NA,7.27,,1.69,17.74,17.74,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00