CPT code 19368: TRAM reconstruction2026 Medicare rate & RVUs in Utah
Reports breast reconstruction using a single-pedicle TRAM flap transferred with microvascular anastomosis, commonly after mastectomy.
CMS doesn’t publish an office rate for 19368 in Utah.
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 19368 covers
This service reconstructs a breast with tissue from the lower abdomen that includes skin, fat, and rectus abdominis muscle. The surgeon transfers the single-pedicle TRAM flap and performs microvascular anastomosis to establish its blood supply at the recipient site. Plastic and reconstructive surgeons typically perform the procedure in a hospital operating room, often as reconstruction following mastectomy. The flap transfer and its microvascular anastomosis are central to distinguishing this service from a TRAM flap that remains attached to its native pedicle.
Report the code when the operative record supports a single-pedicle TRAM reconstruction with microvascular anastomosis. Documentation should identify the flap and pedicle, the transfer and anastomosis performed, and the reconstructed side or sides. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple procedures, the highest-valued procedure is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; 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.
19368 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $1,830.90 |
How the 19368 rate is calculated
Each of 19368’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 · 19368
RVUs × geographic indexes × conversion factor
Work33.05
33.05 RVUs× 1.000 GPCI
Practice expense17.28
17.28 RVUs× 1.000 GPCI
Malpractice6.15
6.15 RVUs× 1.000 GPCI
Adjusted RVUs
56.4800
Conversion factor
$33.4009
Medicare rate
$1,886.48
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19368
19368 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19368
TRAM 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 · 19368
TRAM 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
19368 without 50 · national facility
$1,886.48
TRAM reconstruction
19368-50 · Bilateral: 150%
$2,829.72
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).
19368 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 19367Breast reconstruction
- Both describe single-pedicle TRAM reconstruction; choose 19368 when the service includes microvascular anastomosis, and 19367 for the TRAM flap service without that distinction.
- 19369TRAM flap reconstruction
- 19369 describes a bipedicled TRAM flap. 19368 is the single-pedicle TRAM service with microvascular anastomosis.
- 19364Free-flap reconstruction
- 19364 covers breast reconstruction with a free flap generally; 19368 identifies the single-pedicle TRAM flap with microvascular anastomosis.
- 19361Breast reconstruction
- 19361 uses a latissimus dorsi flap. 19368 uses a single-pedicle TRAM flap from the lower abdomen with microvascular anastomosis.
19368 billing questions
How does 19368 differ from 19367?
19368 describes a single-pedicle TRAM flap with microvascular anastomosis. 19367 is the single-pedicle TRAM flap service without that anastomosis distinction.
Is the microvascular anastomosis included?
Yes. It is part of the 19368 service, so the anastomosis used to transfer the TRAM flap is not a separate service under this code.
When would 19364 be considered instead?
19364 is used for breast reconstruction with a free flap other than the specifically described single-pedicle TRAM flap with microvascular anastomosis.
How is bilateral reconstruction handled?
CMS identifies this as a bilateral procedure: modifier 50 is paid at 150%. Document the reconstruction performed on each side.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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