Summary & Overview
CPT 19318: Reduction Mammoplasty
Headline: CPT 19318: Reduction Mammoplasty — Surgical Breast Reduction Procedure
Lead: CPT 19318 denotes reduction mammoplasty, a plastic surgery procedure to remove excess breast tissue and reshape the breast to improve size proportion and relieve symptomatic burden. The code is widely used across outpatient hospital settings and has relevance for surgical planning, coverage determinations, and quality monitoring.
What this code represents and why it matters: Reduction mammoplasty addresses functional and aesthetic issues related to macromastia, including pain, skin irritation, and activity limitations. Nationally, accurate coding of CPT 19318 influences utilization tracking, prior authorization workflows, and reimbursement for reconstructive and reduction breast surgery.
Key payers covered: This summary addresses coverage considerations involving Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides a concise overview of clinical context for CPT 19318, common billing and coding adjuncts, relevant diagnosis pairings, and related CPT procedures for comparison. Readers will find benchmarks for site-of-service patterns, typical coding modifiers encountered, and how CPT 19318 relates to adjacent breast surgery CPT codes used in reconstruction and mastopexy workflows.
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CPT Code Overview
CPT 19318: Reduction mammoplasty is a surgical procedure to reduce breast size by removing excess breast tissue, fat, and skin to achieve a breast size in proportion with the body and to alleviate symptoms associated with macromastia. This code is categorized under Plastic Surgery and is typically performed in an Outpatient Hospital (POS 22) setting.
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Clinical & Coding Specifications
Clinical Context
A 38-year-old female presents to a plastic surgery clinic with symptomatic breast hypertrophy causing back, neck, and shoulder pain and skin irritation beneath the inframammary fold. Nonoperative management including physical therapy and analgesics provided limited relief. After evaluation by a board-certified plastic surgeon, the patient elects to undergo 19318 (reduction mammoplasty) on an outpatient hospital day-surgery basis (POS 22). Preoperative steps include history and physical, photographic documentation, marking of reduction pattern, informed consent, and pre-anesthesia evaluation. On the day of surgery the procedure is performed under general anesthesia with tissue resection, reshaping of the breast mound, and nipple-areolar complex repositioning. Typical postoperative workflow includes routine recovery in the ambulatory PACU, discharge with wound care and activity restrictions, and scheduled outpatient follow-up for suture removal and assessment of healing. Aftercare visits for resolution of pain or wound issues are coded separately as applicable.
Coding Specifications
Modifier usage and definitions:
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50- Bilateral Procedure -
Use when a bilateral
19318reduction mammoplasty is performed and a bilateral billing indicator is required. -
RT- Right Side -
Use to identify a procedure performed on the right breast when single‑side reporting is required.
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- Left Side