No office rate
Use 19361 for reconstruction with a pedicled latissimus dorsi flap. Code 19364 describes transfer of free tissue with microsurgical vascular connections.
On this page
CMS RVU26D · Effective 2026-10-01
19364 Free-flap reconstruction Medicare reimbursement rates in Missouri
Reports breast reconstruction using a free flap of the patient’s own tissue, transferred to the chest and connected through microsurgical vessel anastomoses. Compare 19364 office and facility rates across CMS payment localities in Missouri.
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 19364 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2263.52–$2335.54
3 of 3 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.
Where 19364 pays more and less in Missouri
Breast reconstruction
About 19364: Breast reconstruction with free tissue flap
Reports breast reconstruction using a free flap of the patient’s own tissue, transferred to the chest and connected through microsurgical vessel anastomoses.
Code 19364 represents autologous breast reconstruction using tissue detached from a donor site and transferred to the chest, with its blood vessels connected microsurgically. Plastic and reconstructive surgeons commonly use abdominal perforator tissue, such as a DIEP flap; selected cases use tissue from the thigh or buttock. Reconstruction may be performed during mastectomy or later, typically in a hospital operating room.
Report the service for the free-flap reconstruction, not for a pedicled flap that remains attached to its original blood supply. The operative report should identify the flap and donor site, document the transfer and vascular connections, and specify the reconstructed side. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 19364
- 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 RVU41.52 · 59%
- Practice expense (office) RVU21.49 · 30%
- Malpractice RVU7.93 · 11%
1.3K
Medicare services in 2024 · #2788 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.
19364 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
Code 19367 describes a single-pedicle TRAM flap without microvascular anastomosis; 19364 is for free-flap transfer.
No office rate
Code 19368 is specific to a single-pedicle TRAM reconstruction with microvascular anastomosis. Select 19364 when the documented free flap is not reported under that specific TRAM code.
No office rate
Code 19357 reports placement of a tissue expander, commonly as a staged implant-based approach; 19364 reports reconstruction with transferred autologous free tissue.
Compare 19364 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$2319.58
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$2335.54
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$2263.52
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19364 billing questions
How does 19364 differ from a pedicled TRAM flap?
Code 19364 is for tissue completely detached and transferred as a free flap, with microsurgical vessel connections. A pedicled TRAM flap remains attached to its original blood supply and is reported using the applicable TRAM code.
Can 19364 be reported with a mastectomy?
Yes. Immediate free-flap reconstruction may be performed in the same session as a mastectomy, with each service reported when supported by the operative documentation.
How is bilateral free-flap reconstruction reported?
When reconstruction is performed on both breasts, report the bilateral procedure with modifier 50. CMS payment for the bilateral procedure is 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care. Routine follow-up for the reconstruction during that period is part of the global service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons are paid only when supporting documentation is provided; 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.
1,70019355,,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
1,70619369,,Brst rcnstj 2 pdcl tram flap,A,,30.53,16.36,NA,16.36,,5.68,52.57,52.57,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00