No office rate
Choose 19361 for a latissimus flap transferred with its blood supply maintained. Code 19364 describes reconstruction with a free flap requiring transfer as free tissue.
On this page
CMS RVU26D · Effective 2026-10-01
19361 Breast reconstruction Medicare reimbursement rates in Massachusetts
Reports breast reconstruction using a latissimus dorsi flap moved from the back to the chest, commonly after mastectomy. Compare 19361 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 19361 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
$1390.55–$1490.29
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 reconstruction
About 19361: Pedicled latissimus breast reconstruction
Reports breast reconstruction using a latissimus dorsi flap moved from the back to the chest, commonly after mastectomy.
A surgeon, commonly a plastic surgeon, reconstructs the breast by moving latissimus dorsi tissue from the back to the chest while maintaining its blood supply. The flap may include overlying skin, depending on the reconstructive plan. This approach is used for breast reconstruction, often after mastectomy, and is generally performed in a hospital or other facility setting.
Report 19361 when the operative work reconstructs the breast with a latissimus dorsi flap; document the indication, recipient site, flap source, and operative technique. CMS assigns major-surgery status, so the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19361
- 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 RVU22.78 · 55%
- Practice expense (office) RVU14.31 · 35%
- Malpractice RVU4.29 · 10%
558
Medicare services in 2024 · #3460 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.
19361 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Code 19367 describes reconstruction with a pedicled TRAM flap from the abdomen. Code 19361 uses latissimus dorsi tissue from the back.
No office rate
Code 19357 is for tissue-expander placement, not reconstruction with a latissimus dorsi flap.
Compare 19361 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
$1490.29
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1390.55
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19361 billing questions
How is 19361 different from a free-flap reconstruction?
19361 describes a latissimus dorsi flap moved to the chest with its blood supply maintained. A free flap is detached and transferred using microsurgical reconnection of its blood vessels.
Can 19361 be reported for both breasts?
For bilateral work, CMS identifies modifier 50 and pays the procedure at 150%. The operative report should establish that reconstruction was performed on both sides.
Does the 90-day global include postoperative visits?
Yes. The major-surgery global includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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.
1,69919350,,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
1,70419367,,Brst rcnstj 1 pdcl tram flap,A,,26.13,15.70,NA,15.70,,4.85,46.68,46.68,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70519368,,Brst rcnstj 1pdcl tram anast,A,,33.05,17.28,NA,17.28,,6.15,56.48,56.48,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00