Billing code 19342: Breast implantMedicare rate & RVUs in Ohio
Reports breast implant placement or replacement performed on a separate date from mastectomy, including delayed implant reconstruction after tissue-expander treatment.
CMS doesn’t publish an office rate for 19342 in Ohio.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 19342 covers
This code covers placement of a breast implant for reconstruction on a date separate from mastectomy, as well as replacement of an implant in this reconstructive setting. A plastic surgeon or breast surgeon may perform it in a hospital outpatient department, ambulatory surgery center, or office-based operating setting. A common pathway is exchange of a tissue expander for a permanent implant after mastectomy and completion of expansion.
Select the code based on the operative circumstances: the implant procedure must occur separately from the mastectomy, rather than during the mastectomy session. The operative report should identify the breast and side, the reconstructive history, and whether an implant was placed or replaced. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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 requires documented medical necessity; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
19342 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $669.75 |
How the 19342 rate is calculated
Each of 19342’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 19342
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.22Practice expense 8.66Malpractice 1.91
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19342
19342 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19342
Breast implant
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19342
Breast implant
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19342 without 50 · national facility
$694.40
Breast implant
19342-50 · Bilateral: 150%
$1,041.60
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
19342 compared with similar codes
Compare codes
19342 vs 19340 vs 19357 vs 19325: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19340Breast implant
- The key distinction is timing: 19340 describes implant placement during the mastectomy session; 19342 is for implant placement or replacement on a separate date.
- 19357Breast reconstruction
- 19357 covers placement of a tissue expander for reconstruction. This code covers breast implant placement or replacement, often after expansion is complete.
- 19325Breast augmentation
- 19325 is for breast augmentation with an implant, rather than implant placement or replacement in the postmastectomy reconstructive setting.
19342 billing questions
How is this code different from 19340?
Use 19342 when implant placement or replacement occurs on a date separate from mastectomy. Code 19340 is for implant placement in the mastectomy session.
Can this code be used for tissue-expander placement?
No. It describes breast implant placement or replacement, not placement of a tissue expander. Tissue-expander placement for reconstruction is represented by 19357.
What documentation supports reporting this code?
The operative report should establish the reconstructive context, the separate timing from mastectomy, the implant procedure performed, and the treated side.
How is bilateral reporting handled?
CMS pays a bilateral procedure reported with modifier 50 at 150%. The operative documentation should support implant work on both breasts.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When may an assistant or co-surgeon be paid?
Assistant-at-surgery payment requires documentation of medical necessity. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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