No office rate
Both describe single-pedicle TRAM reconstruction; choose 19368 when the service includes microvascular anastomosis, and 19367 for the TRAM flap service without that distinction.
On this page
CMS RVU26D · Effective 2026-10-01
19368 TRAM reconstruction Medicare reimbursement rates in Missouri
Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy. Compare 19368 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 19368 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
$1801.49–$1859.19
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 19368 pays more and less in Missouri
Breast reconstruction
About 19368: Single-pedicle TRAM breast reconstruction with anastomosis
Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy.
This service reconstructs a breast with tissue from the lower abdomen that includes skin, fat, and rectus abdominis muscle. The surgeon transfers the single-pedicle TRAM flap and performs microvascular anastomosis to establish its blood supply at the recipient site. Plastic and reconstructive surgeons typically perform the procedure in a hospital operating room, often as reconstruction following mastectomy. The flap transfer and its microvascular anastomosis are central to distinguishing this service from a TRAM flap that remains attached to its native pedicle.
Report the code when the operative record supports a single-pedicle TRAM reconstruction with microvascular anastomosis. Documentation should identify the flap and pedicle, the transfer and anastomosis performed, and the reconstructed side or sides. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple 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 made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19368
- 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 RVU33.05 · 59%
- Practice expense (office) RVU17.28 · 31%
- Malpractice RVU6.15 · 11%
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.
19368 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
19369 describes a bipedicled TRAM flap. 19368 is the single-pedicle TRAM service with microvascular anastomosis.
No office rate
19364 covers breast reconstruction with a free flap generally; 19368 identifies the single-pedicle TRAM flap with microvascular anastomosis.
No office rate
19361 uses a latissimus dorsi flap. 19368 uses a single-pedicle TRAM flap from the lower abdomen with microvascular anastomosis.
Compare 19368 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
$1846.55
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$1859.19
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$1801.49
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19368 billing questions
How does 19368 differ from 19367?
19368 describes a single-pedicle TRAM flap with microvascular anastomosis. 19367 is the single-pedicle TRAM flap service without that anastomosis distinction.
Is the microvascular anastomosis included?
Yes. It is part of the 19368 service, so the anastomosis used to transfer the TRAM flap is not a separate service under this code.
When would 19364 be considered instead?
19364 is used for breast reconstruction with a free flap other than the specifically described single-pedicle TRAM flap with microvascular anastomosis.
How is bilateral reconstruction handled?
CMS identifies this as a bilateral procedure: modifier 50 is paid at 150%. Document the reconstruction performed on each side.
What postoperative care is included?
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 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.
1,70219361,,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
1,70719370,,Revj peri-implt capsule brst,A,,8.94,7.82,NA,7.82,,1.68,18.44,18.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70819371,,Peri-implt capslc brst compl,A,,9.73,7.87,NA,7.87,,1.84,19.44,19.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00