No office rate
Both use a single-pedicle TRAM flap. Choose 19368 when the flap is transferred with microvascular anastomosis; 19367 is the pedicled approach without that anastomosis.
On this page
CMS RVU26D · Effective 2026-10-01
19367 Breast reconstruction Medicare reimbursement rates in New Jersey
Reports breast reconstruction using an abdominal single-pedicle TRAM flap, typically after mastectomy, when the flap remains attached to its vascular supply. Compare 19367 office and facility rates across CMS payment localities in New Jersey.
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 19367 in New Jersey?
New Jersey 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
$1658.02–$1709.06
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 19367: Breast reconstruction with single-pedicle TRAM flap
Reports breast reconstruction using an abdominal single-pedicle TRAM flap, typically after mastectomy, when the flap remains attached to its vascular supply.
The surgeon uses skin, fat, and a portion of rectus abdominis muscle from the abdomen to form a breast mound. The flap is tunneled to the chest while remaining connected to its original blood supply; this distinguishes the service from a free flap requiring microvascular reconnection. Plastic surgeons commonly perform this reconstruction after mastectomy in a hospital or other facility setting. The abdominal donor site is also closed as part of the reconstructive operation.
Select this code for the single-pedicle TRAM approach without microvascular anastomosis; a single-pedicle flap with microvascular anastomosis and a two-pedicle flap have separate codes. Document the flap technique, laterality, and reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, 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 allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19367
- 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 RVU26.13 · 56%
- Practice expense (office) RVU15.70 · 34%
- Malpractice RVU4.85 · 10%
24
Medicare services in 2024 · #5802 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.
19367 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
19369 describes a two-pedicle TRAM flap. For 19367, the reconstruction uses one pedicle.
No office rate
19364 is reconstruction with a free flap, which requires microvascular reconnection. In 19367, the TRAM flap remains attached to its original blood supply.
No office rate
19361 uses tissue from the latissimus dorsi in the back; 19367 uses abdominal tissue and rectus muscle.
Compare 19367 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$1709.06
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$1658.02
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19367 billing questions
How is 19367 distinguished from 19368?
19367 describes a single-pedicle TRAM flap that remains connected to its blood supply. Use 19368 when the single-pedicle flap involves microvascular anastomosis.
When is 19369 used instead?
19369 is for breast reconstruction using a two-pedicle TRAM flap. The number of pedicles used, rather than the size of the reconstruction, distinguishes it from 19367.
Can the mastectomy be reported in the same session?
The mastectomy and the TRAM-flap reconstruction are distinct services and may be reported for the same session when both are performed. For same-session procedures, CMS applies the standard multiple procedure reduction.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. The operative record should identify the flap method and laterality.
How is bilateral reconstruction handled?
CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%. Document the reconstruction performed on each side.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. 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.
1,70119357,,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
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