$790.71–$921.13
Choose 19355 for an inverted nipple; choose 19350 when reconstructing the nipple and areola, commonly after mastectomy.
On this page
CMS RVU26D · Effective 2026-10-01
19350 Nipple reconstruction Medicare reimbursement rates in Virginia
Reports surgical reconstruction of the nipple and areola, commonly as a later stage of breast reconstruction after mastectomy. Compare 19350 office and facility rates across CMS payment localities in Virginia.
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 19350 in Virginia?
Virginia 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
$868.20–$1012.50
2 of 2 localities have a supported rate.
Facility setting
$595.03–$685.14
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 19350: Nipple and areola reconstruction
Reports surgical reconstruction of the nipple and areola, commonly as a later stage of breast reconstruction after mastectomy.
This service recreates the nipple and areola, most often after mastectomy and reconstruction of the breast mound. A plastic surgeon or other surgeon experienced in breast reconstruction may use local tissue rearrangement to create nipple projection and grafting or other reconstructive techniques for the areola. It is commonly performed in an outpatient or hospital setting as a later stage of reconstruction.
Report 19350 for the nipple-and-areola reconstruction itself, not for correction of an inverted nipple or a broader revision of the reconstructed breast. The operative note should describe the reconstructed anatomy and work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 19350
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.88 · 33%
- Practice expense (office) RVU16.21 · 61%
- Malpractice RVU1.67 · 6%
776
Medicare services in 2024 · #3185 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.
19350 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
19380 covers revision of a reconstructed breast. 19350 is specific to nipple-and-areola reconstruction.
No office rate
19357 describes tissue-expander placement for breast reconstruction; 19350 addresses reconstruction of the nipple and areola.
Compare 19350 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
Dc + Md/Va Suburbs →
Office / nonfacility
$1012.50
Facility
$685.14
Virginia →
Office / nonfacility
$868.20
Facility
$595.03
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19350 billing questions
How is 19350 different from 19355?
19350 is for reconstructing the nipple and areola, usually after mastectomy. 19355 addresses an inverted nipple rather than creating a nipple–areola complex.
When should a broader breast revision be reported instead?
Use 19380 when the documented work revises the reconstructed breast more broadly, such as its contour or overall reconstruction. Use 19350 for nipple-and-areola reconstruction.
Does 19350 include the breast mound reconstruction?
No. It describes nipple-and-areola reconstruction; breast mound reconstruction is a separate service when performed and supported by the operative documentation.
How should bilateral reconstruction be reported?
CMS identifies 19350 as a bilateral procedure: reporting modifier 50 results in payment at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care. The operative note should support the reconstructive work and the postoperative record should reflect care related to that surgery.
Can an assistant or co-surgeon be paid for this procedure?
CMS applies a statutory restriction on assistant-at-surgery payment for 19350. Co-surgeons and team surgery are 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.
1,69619330,,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
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