No office rate
Choose 19340 when the implant is placed during the mastectomy operation. Choose 19342 for implant insertion or replacement in a separate session.
On this page
CMS RVU26D · Effective 2026-10-01
19340 Breast implant Medicare reimbursement rates in Pennsylvania
Reports direct placement of a breast implant during the mastectomy operation for immediate reconstruction, rather than staged reconstruction with a tissue expander. Compare 19340 office and facility rates across CMS payment localities in Pennsylvania.
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 19340 in Pennsylvania?
Pennsylvania 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
$673.40–$732.18
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 19340: Immediate breast implant reconstruction
Reports direct placement of a breast implant during the mastectomy operation for immediate reconstruction, rather than staged reconstruction with a tissue expander.
A surgeon places a breast implant during the same operative session as a mastectomy to create an immediate breast reconstruction. This approach may follow mastectomy for breast cancer or risk reduction. Plastic surgeons commonly perform the reconstruction, sometimes with a breast surgeon performing the mastectomy, in a hospital or ambulatory surgical setting. The implant is placed directly; a tissue expander is not used as the initial reconstructive device.
Report 19340 for immediate implant placement, with the mastectomy coded separately when performed. The operative report should identify the mastectomy session, laterality, reconstructive purpose, and implant placement. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 identifies bilateral surgery, paid at 150%. Assistant-at-surgery payment is statutorily restricted; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 19340
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.22 · 49%
- Practice expense (office) RVU8.76 · 42%
- Malpractice RVU2.01 · 10%
1.4K
Medicare services in 2024 · #2718 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.
19340 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
19357 is for placement of a tissue expander as a staged reconstructive step; 19340 is for direct implant placement during mastectomy.
No office rate
19325 describes breast augmentation with an implant, rather than implant reconstruction performed in the mastectomy session.
Compare 19340 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$732.18
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$673.40
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19340 billing questions
How is 19340 different from 19342?
19340 describes implant placement in the same operative session as mastectomy. 19342 is used for implant insertion or replacement in a separate, later reconstruction session.
When is 19357 reported instead?
Use 19357 when the surgeon places a tissue expander as a staged step in breast reconstruction. Code 19340 describes direct implant placement during the mastectomy operation.
Is the mastectomy reported separately?
Yes. Report the applicable mastectomy procedure separately from the immediate implant reconstruction when both services are performed.
How should bilateral placement be reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support implant placement on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care. Related follow-up during that period is part of the global service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is statutorily restricted. Co-surgeons are paid only with supporting documentation, and 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.
1,69419325,,Breast augmentation w/implt,A,,7.92,7.55,NA,7.55,,1.48,16.95,16.95,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69519328,,Rmvl intact breast implant,A,,7.25,6.72,NA,6.72,,1.40,15.37,15.37,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69619330,,Rmvl ruptured breast implant,A,,8.78,7.27,NA,7.27,,1.69,17.74,17.74,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69719340,,Insj breast implt sm d mast,A,,10.22,8.76,NA,8.76,,2.01,20.99,20.99,0,090,0.10,0.71,0.19,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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