No office rate
Choose 19316 for lifting and reshaping when improved position is the main goal. Choose 19318 when reducing breast volume is the primary work.
On this page
CMS RVU26D · Effective 2026-10-01
19316 Breast lift Medicare reimbursement rates in Massachusetts
Reports an operation that elevates and reshapes a ptotic breast, generally by removing excess skin and repositioning breast tissue and the nipple-areola complex. Compare 19316 office and facility rates across CMS payment localities in Massachusetts.
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 19316 in Massachusetts?
Massachusetts 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
$736.21–$793.72
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.
Breast surgery
About 19316: Breast lift for ptosis
Reports an operation that elevates and reshapes a ptotic breast, generally by removing excess skin and repositioning breast tissue and the nipple-areola complex.
This operation lifts and reshapes a breast by removing excess skin and repositioning breast tissue and the nipple-areola complex higher on the chest. Plastic surgeons commonly perform it for breast drooping after pregnancy, weight change, or aging, usually in an ambulatory surgery center or hospital operating room. The main goal is improved position and contour, rather than substantial removal of breast volume. A lift may be combined with implant augmentation when the patient also seeks increased volume.
Report the procedure for each treated breast and document the indication, laterality, operative work, and any accompanying procedure. For bilateral surgery, CMS pays reporting with modifier 50 at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19316
- 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 RVU10.81 · 50%
- Practice expense (office) RVU8.89 · 41%
- Malpractice RVU2.13 · 10%
3.4K
Medicare services in 2024 · #2093 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.
19316 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
19325 reports implant augmentation to increase breast volume. It may accompany 19316 when the same operation also lifts and reshapes the breast.
No office rate
19380 is for revision of a reconstructed breast. This code addresses lifting and reshaping a ptotic breast, not revision of a reconstruction.
Compare 19316 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
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$793.72
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$736.21
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19316 billing questions
How is this procedure distinguished from breast reduction?
Use this code when the principal work is lifting and reshaping a drooping breast. Code 19318 describes reduction when breast-volume removal is the primary objective.
Can this be reported with breast augmentation?
Yes, a lift and implant augmentation may be performed in the same session when both contour and volume are being addressed. CMS applies its multiple procedure reduction when procedures are performed together.
How should bilateral surgery be reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care. Document separately identifiable services when they are outside that included care.
May an assistant or co-surgeon be paid?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and 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 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.
1,68919305,,Mast radical,A,,17.02,11.42,NA,11.42,,4.39,32.83,32.83,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69019306,,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