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CMS RVU26D · Effective 2026-10-01

19369 TRAM flap reconstruction Medicare reimbursement rates in Oklahoma

Reports breast reconstruction using a pedicled abdominal TRAM flap supplied by two pedicles, typically after mastectomy when autologous tissue is selected. Compare 19369 office and facility rates across CMS payment localities in Oklahoma.

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 19369 in Oklahoma?

Oklahoma 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

$1655.11

1 of 1 localities have a supported rate.

Payment area: Oklahoma

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.

Find 19369 in your payment locality →

Breast reconstruction

About 19369: Breast reconstruction with bipedicled TRAM flap

Reports breast reconstruction using a pedicled abdominal TRAM flap supplied by two pedicles, typically after mastectomy when autologous tissue is selected.

A surgeon transfers lower abdominal skin, fat, and associated rectus muscle to create a breast mound, maintaining blood supply through two pedicles. Plastic surgeons commonly perform this reconstruction after mastectomy, either during the mastectomy operation or as a later procedure. The operative report should identify the abdominal tissue transferred and document the two-pedicle technique; this is distinct from a free flap transferred with microvascular reconnection.

Select this code for the two-pedicle TRAM approach, rather than a one-pedicle TRAM or another flap method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. For bilateral procedures reported with modifier 50, CMS pays at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 19369

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 RVU30.53 · 58%
  • Practice expense (office) RVU16.36 · 31%
  • Malpractice RVU5.68 · 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.

19369 compared with similar codes

Office rates for Oklahoma, from the same CMS release.

19367

Breast reconstruction

Single-pedicle TRAM flap

No office rate

Choose 19367 for a one-pedicle TRAM flap. Code 19369 identifies the two-pedicle technique.

19368

TRAM reconstruction

Single pedicle, microvascular

No office rate

Code 19368 describes a one-pedicle TRAM flap with microvascular anastomosis; 19369 is the two-pedicle TRAM approach.

19364

Free-flap reconstruction

Autologous free tissue

No office rate

Code 19364 is for free-flap breast reconstruction, in which tissue is transferred and reconnected microsurgically. Code 19369 uses a pedicled TRAM flap.

19361

Breast reconstruction

Latissimus dorsi flap

No office rate

Code 19361 uses a latissimus dorsi flap from the back. Code 19369 uses pedicled abdominal TRAM tissue.

Compare 19369 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

Office and facility base rates · shared scale starting at $0

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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 19369 in Oklahoma.

PPRRVU2026_Oct_nonQPP.csv

1,706

Code
19369
Physician work
30.53
Practice expense
16.36
Malpractice
5.68

GPCI2026.csv

86

Locality
Oklahoma
Physician work
1.000
Practice expense
0.893
Malpractice
0.777
Facility calculation for 19369 in Oklahoma
ComponentRVULocality factorAdjusted
Physician work30.53× 1.00030.5300
Practice expense16.36× 0.89314.6095
Malpractice5.68× 0.7774.4134
Total RVUs49.5528
Conversion factor× 33.4009

Facility rate, Oklahoma$1655.11

Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work30.531
Practice expense16.360.893
Malpractice5.680.777

(30.53 × 1 + 16.36 × 0.893 + 5.68 × 0.777) × $33.4009 = $1655.11

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.

19369 billing questions

How is this different from a one-pedicle TRAM flap?

This code is for a TRAM flap supplied by two pedicles. Use the one-pedicle code when the operative technique uses one pedicle.

Does two-pedicle mean reconstruction of both breasts?

No. Two-pedicle describes the flap technique for a reconstruction. Modifier 50 represents a bilateral procedure when both breasts are reconstructed.

What operative documentation supports this code?

Document the abdominal tissue transferred, the pedicled flap technique, and use of two pedicles. Include the reconstructed side or sides.

Is routine postoperative flap care separately reported?

Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.

Can the mastectomy be reported with the reconstruction?

When mastectomy and immediate TRAM reconstruction are performed in the same session, the mastectomy may be reported with the reconstruction. CMS applies its multiple-procedure payment rule to same-session procedures.

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.

RVUs for 19369PPRRVU2026_Oct_nonQPP.csv, line 1,706 (RVU26D)
Geographic factors for OklahomaGPCI2026.csv, line 86 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet