Billing code 19369: TRAM flap reconstructionMedicare rate & RVUs in Texas
Reports breast reconstruction using a pedicled abdominal TRAM flap supplied by two pedicles, typically after mastectomy when autologous tissue is selected.
CMS doesn’t publish an office rate for 19369 in Texas.
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 19369 covers
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.
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.
Where 19369 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,767.99 |
| Beaumont | Unavailable | $1,693.24 |
| Brazoria | Unavailable | $1,717.39 |
| Dallas | Unavailable | $1,735.94 |
| Fort Worth | Unavailable | $1,732.94 |
| Galveston | Unavailable | $1,727.59 |
| Houston | Unavailable | $1,831.55 |
| Rest Of Texas | Unavailable | $1,709.61 |
How the 19369 rate is calculated
Each of 19369’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 · 19369
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 30.53Practice expense 16.36Malpractice 5.68
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19369
19369 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19369
TRAM flap reconstruction
| 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) | 2 | Paid. |
| 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 · 19369
TRAM flap reconstruction
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
19369 without 50 · national facility
$1,755.89
TRAM flap reconstruction
19369-50 · Bilateral: 150%
$2,633.84
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).
19369 compared with similar codes
Compare codes
19369 vs 19367 vs 19368 vs 19364 vs 19361: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19367Breast reconstruction
- Choose 19367 for a one-pedicle TRAM flap. Code 19369 identifies the two-pedicle technique.
- 19368TRAM reconstruction
- Code 19368 describes a one-pedicle TRAM flap with microvascular anastomosis; 19369 is the two-pedicle TRAM approach.
- 19364Free-flap reconstruction
- Code 19364 is for free-flap breast reconstruction, in which tissue is transferred and reconnected microsurgically. Code 19369 uses a pedicled TRAM flap.
- 19361Breast reconstruction
- Code 19361 uses a latissimus dorsi flap from the back. Code 19369 uses pedicled abdominal TRAM tissue.
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 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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