No office rate
19340 represents direct implant placement at the mastectomy operation. Use 19357 when a tissue expander is placed for staged reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
19357 Breast reconstruction Medicare reimbursement rates in Ohio
Placement of a breast tissue expander for immediate or delayed reconstruction, with planned subsequent expansion included in the reconstruction service. Compare 19357 office and facility rates across CMS payment localities in Ohio.
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 19357 in Ohio?
Ohio has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1030.18
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
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 19357: Breast reconstruction with tissue expander
Placement of a breast tissue expander for immediate or delayed reconstruction, with planned subsequent expansion included in the reconstruction service.
A plastic or reconstructive surgeon places a temporary, inflatable device in the breast pocket to create or restore breast volume after mastectomy. Placement may be performed during the mastectomy operation or as a delayed reconstruction. The patient typically returns for staged expansion as the device is filled over time, before a later reconstructive step such as implant exchange.
Report 19357 for the expander-based reconstruction, not again for each planned fill. Documentation should identify the reconstructed side, whether reconstruction is immediate or delayed, and the operative work establishing the expander. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For bilateral work, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 19357
- 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 RVU14.47 · 45%
- Practice expense (office) RVU14.93 · 46%
- Malpractice RVU2.72 · 8%
4.8K
Medicare services in 2024 · #1895 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.
19357 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
19342 represents implant insertion or replacement on a separate day from mastectomy, including a later expander-to-implant exchange. It is not the initial expander placement.
No office rate
19361 reconstructs the breast using a latissimus dorsi flap. 19357 describes reconstruction that begins with placement of a tissue expander.
No office rate
19364 uses a free flap for breast reconstruction; 19357 uses a tissue expander rather than transferred free tissue.
Compare 19357 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.
1 of 1 payment localities
Ohio →
Office / nonfacility
Unavailable
Facility
$1030.18
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 19357 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
1,701
- Code
- 19357
- Physician work
- 14.47
- Practice expense
- 14.93
- Malpractice
- 2.72
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.47 | × 1.000 | 14.4700 |
| Practice expense | 14.93 | × 0.913 | 13.6311 |
| Malpractice | 2.72 | × 1.008 | 2.7418 |
| Total RVUs | 30.8428 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$1030.18
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.47 | 1 |
| Practice expense | 14.93 | 0.913 |
| Malpractice | 2.72 | 1.008 |
(14.47 × 1 + 14.93 × 0.913 + 2.72 × 1.008) × $33.4009 = $1030.18
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
19357 billing questions
When is 19357 used instead of direct implant placement?
Use 19357 when reconstruction is staged with a tissue expander. Direct implant placement at the mastectomy operation is represented by 19340.
Can each expander-fill visit be billed as 19357?
No. Planned subsequent expansion is included in the reconstruction service; 19357 is not reported again for each fill.
Can 19357 be reported with a mastectomy code?
It may be performed in the same session as a mastectomy when immediate reconstruction is planned. The CMS multiple-procedure reduction applies to procedures performed in the same session.
How is bilateral expander placement reported?
For bilateral work, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Planned expander expansion is also part of the reconstruction service.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with 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.
1,69819342,,Insj/rplcmt brst implt sep d,A,,10.22,8.66,NA,8.66,,1.91,20.79,20.79,0,090,0.10,0.71,0.19,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703