No office rate
Use 19371 for complete capsule removal with intracapsular contents. Use 19370 when the capsule is revised but not completely excised.
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CMS RVU26D · Effective 2026-10-01
19371 Capsulectomy Medicare reimbursement rates in Virginia
Reports complete removal of the capsule surrounding a breast implant, including its contents, when the surgeon performs a full capsulectomy. Compare 19371 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 19371 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
No supported rate
Facility setting
$626.78–$720.60
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 surgery
About 19371: Complete breast implant capsulectomy
Reports complete removal of the capsule surrounding a breast implant, including its contents, when the surgeon performs a full capsulectomy.
This operation removes the fibrous capsule surrounding a breast implant in its entirety and removes material contained within that capsule, including the implant. Plastic and reconstructive surgeons commonly perform it in an operating room for a contracted capsule, an implant-related complication, or a revision in which complete capsule removal is intended. The code describes capsule excision, not simple implant removal or a limited capsule release.
Report the service for each breast treated. The operative note should establish complete rather than partial capsule removal, identify the side, and describe the capsule and intracapsular contents removed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. CMS does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 19371
- 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 RVU9.73 · 50%
- Practice expense (office) RVU7.87 · 40%
- Malpractice RVU1.84 · 9%
4.7K
Medicare services in 2024 · #1906 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.
19371 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
19328 describes removal of an intact implant. 19371 includes implant removal when the surgeon also performs complete capsulectomy.
No office rate
19330 describes removal of a ruptured implant. 19371 is distinguished by complete excision of the surrounding capsule as well as removal of its contents.
No office rate
19342 describes insertion or replacement of an implant; 19371 describes complete removal of the peri-implant capsule and existing intracapsular contents.
Compare 19371 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
Unavailable
Facility
$720.60
Virginia →
Office / nonfacility
Unavailable
Facility
$626.78
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19371 billing questions
How does 19371 differ from 19370?
19371 is for complete removal of the peri-implant capsule and its contents. 19370 describes revision of the capsule when the work is not a complete capsulectomy.
Does 19371 include removal of the implant?
Yes. Removal of the implant within the capsule is included, so do not separately report 19328 or 19330 for that same removal.
Can 19371 be reported when a new implant is placed?
19371 covers the complete capsule removal and removal of the existing implant. When a replacement implant is placed, 19342 may describe that placement when its requirements are met.
How is bilateral capsulectomy reported?
Report modifier 50 when the complete procedure is performed on both breasts. CMS pays bilateral 19371 at 150%.
What should the operative note document?
Document the side treated, the extent of capsule excision, and removal of the implant or other intracapsular contents. The record should distinguish complete excision from a limited capsule revision.
Is an assistant surgeon payable for 19371?
CMS does not pay an assistant at surgery for this code. 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.
1,70519368,,Brst rcnstj 1pdcl tram anast,A,,33.05,17.28,NA,17.28,,6.15,56.48,56.48,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70619369,,Brst rcnstj 2 pdcl tram flap,A,,30.53,16.36,NA,16.36,,5.68,52.57,52.57,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70719370,,Revj peri-implt capsule brst,A,,8.94,7.82,NA,7.82,,1.68,18.44,18.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70819371,,Peri-implt capslc brst compl,A,,9.73,7.87,NA,7.87,,1.84,19.44,19.44,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,70919380,,Revj reconstructed breast,A,,10.89,9.09,NA,9.09,,2.05,22.03,22.03,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71019396,,Design custom breast implant,A,,2.12,6.22,,1.27,,0.39,8.73,3.78,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71119499,,Unlisted procedure breast,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00