Summary & Overview

CPT 19357: Tissue Expander Placement for Breast Reconstruction

CPT code 19357 is a nationally recognized billing code for tissue expander placement in breast reconstruction, a procedure commonly performed after mastectomy or other breast surgeries. This code is integral to reconstructive and plastic surgery, enabling gradual expansion of tissue to prepare for permanent breast implants. The procedure is typically conducted in hospital outpatient or inpatient settings, reflecting its complexity and clinical importance.

Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding coverage policies and reimbursement benchmarks for CPT code 19357 is essential for providers, administrators, and policy analysts navigating the evolving landscape of breast reconstruction services.

This publication provides a comprehensive overview of CPT code 19357, including payer coverage, clinical context, and related coding considerations. Readers will gain insights into national policy updates, coding benchmarks, and the role of tissue expander placement in breast reconstruction. The analysis also highlights associated diagnoses and related CPT codes, offering a clear framework for understanding the procedure's place within reconstructive surgery and medical billing.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 19357breast reconstructiontissue expanderplastic surgeryreconstructive surgeryhospital outpatienthospital inpatientmedical billingsurgical oncologyprocedure coding

CPT Code Overview

CPT code 19357 describes the placement of a tissue expander for breast reconstruction. This procedure is a key component of reconstructive surgery, often performed by plastic surgeons following mastectomy or other breast surgeries. The tissue expander is inserted to gradually stretch the skin and muscle, creating space for a permanent breast implant. Typical sites of service for this procedure include hospital outpatient settings (POS 22) and inpatient settings (POS 21). This code is central to the surgical management of patients requiring breast reconstruction, supporting both clinical and billing workflows in hospital environments.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a patient diagnosed with breast cancer or a malignant neoplasm of the breast, such as basal cell carcinoma or squamous cell carcinoma. Following a mastectomy or removal of breast tissue due to cancer, the patient undergoes reconstructive surgery. In this workflow, a plastic or reconstructive surgeon places a tissue expander in the breast area to gradually create space for a future permanent breast prosthesis. The procedure is performed in a hospital outpatient or inpatient setting, often as part of a staged breast reconstruction plan.

Coding Specifications

Modifier Code	Description	When Used
`50`	Bilateral Procedure	When the tissue expander placement is performed on both breasts during the same operative session.
`LT`	Left Side	When the procedure is performed on the left breast only.
`RT`	Right Side	When the procedure is performed on the right breast only.
`59`	Distinct Procedural Service	When the procedure is performed as a distinct service from other procedures, such as when multiple procedures are performed in the same session but are not normally bundled.

Associated Provider Taxonomies:

208200000X - Plastic and Reconstructive Surgery (Plastic surgeons specializing in reconstructive procedures)
2086S0122X - Surgical Oncology (Surgeons specializing in cancer-related surgeries)
208600000X - Surgery (General surgeons performing surgical procedures)

Related Diagnoses

C44.511 - Basal cell carcinoma of skin of breast
- Indicates a malignant skin tumor on the breast, relevant for patients requiring breast reconstruction after cancer removal.
C44.521 - Squamous cell carcinoma of skin of breast
- Represents a different type of skin cancer on the breast, also leading to reconstructive needs.
C44.591 - Other specified malignant neoplasm of skin of breast
- Covers other malignant skin tumors of the breast, necessitating reconstructive surgery.
C50.011 - Malignant neoplasm of nipple and areola, right female breast
- Indicates cancer in the nipple/areola area, right female breast, often requiring mastectomy and reconstruction.
C50.012 - Malignant neoplasm of nipple and areola, left female breast
- Cancer in the nipple/areola area, left female breast, relevant for reconstructive procedures.
C50.021 - Malignant neoplasm of nipple and areola, right male breast
- Cancer in the nipple/areola area, right male breast, may require similar reconstructive approaches.
C50.022 - Malignant neoplasm of nipple and areola, left male breast
- Cancer in the nipple/areola area, left male breast, relevant for reconstruction.
C50.111 - Malignant neoplasm of central portion of right female breast
- Cancer in the central area of the right female breast, leading to tissue removal and reconstruction.
C50.112 - Malignant neoplasm of central portion of left female breast
- Cancer in the central area of the left female breast, necessitating reconstructive surgery.
C50.121 - Malignant neoplasm of central portion of right male breast
- Cancer in the central area of the right male breast, relevant for reconstructive procedures.
C50.122 - Malignant neoplasm of central portion of left male breast
- Cancer in the central area of the left male breast, may require reconstruction.
C50.211 - Malignant neoplasm of upper‑inner quadrant of right female breast
- Cancer in the upper-inner quadrant, right female breast, often leading to partial or total mastectomy and reconstruction.
C50.212 - Malignant neoplasm of upper‑inner quadrant of left female breast
- Cancer in the upper-inner quadrant, left female breast, relevant for reconstructive surgery.
C50.221 - Malignant neoplasm of upper‑inner quadrant of right male breast
- Cancer in the upper-inner quadrant, right male breast, may require reconstruction.
C50.222 - Malignant neoplasm of upper‑inner quadrant of left male breast
- Cancer in the upper-inner quadrant, left male breast, relevant for reconstructive procedures.
C50.311 - Malignant neoplasm of lower‑inner quadrant of right female breast
- Cancer in the lower-inner quadrant, right female breast, leading to reconstructive needs.
C50.312 - Malignant neoplasm of lower‑inner quadrant of left female breast
- Cancer in the lower-inner quadrant, left female breast, relevant for reconstruction.
C50.321 - Malignant neoplasm of lower‑inner quadrant of right male breast
- Cancer in the lower-inner quadrant, right male breast, may require reconstructive surgery.
C50.322 - Malignant neoplasm of lower‑inner quadrant of left male breast
- Cancer in the lower-inner quadrant, left male breast, relevant for reconstruction.
C50.411 - Malignant neoplasm of upper‑outer quadrant of right female breast
- Cancer in the upper-outer quadrant, right female breast, often leading to reconstructive procedures.
C50.412 - Malignant neoplasm of upper‑outer quadrant of left female breast
- Cancer in the upper-outer quadrant, left female breast, relevant for breast reconstruction.

Related CPT Codes

19340 - Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
- Used when a permanent breast prosthesis is placed immediately after breast tissue removal or reconstruction, rather than using a tissue expander.
19342 - Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
- Used when the permanent prosthesis is placed at a later stage, often after tissue expansion with a procedure like 19357.
19350 - Nipple/areola reconstruction
- Performed after breast mound reconstruction, often following procedures like 19357 and prosthesis placement.
11970 - Replacement of tissue expander with permanent prosthesis
- Used in the second stage of reconstruction, after the tissue expander placed with 19357 has achieved adequate expansion.
11971 - Removal of tissue expander(s) without insertion of prosthesis
- Used when the tissue expander is removed without placing a permanent prosthesis, such as in cases of complications or patient preference.

Codes 19340, 19342, 11970, and 11971 are commonly used in sequence or as alternatives depending on the reconstruction plan. 19350 is often used in the final stage of breast reconstruction.

Summary & Overview

CPT 19357: Tissue Expander Placement for Breast Reconstruction

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier Code	Description	When Used
`50`	Bilateral Procedure	When the tissue expander placement is performed on both breasts during the same operative session.
`LT`	Left Side	When the procedure is performed on the left breast only.
`RT`	Right Side	When the procedure is performed on the right breast only.
`59`	Distinct Procedural Service	When the procedure is performed as a distinct service from other procedures, such as when multiple procedures are performed in the same session but are not normally bundled.

Associated Provider Taxonomies:

208200000X - Plastic and Reconstructive Surgery (Plastic surgeons specializing in reconstructive procedures)
2086S0122X - Surgical Oncology (Surgeons specializing in cancer-related surgeries)
208600000X - Surgery (General surgeons performing surgical procedures)

Related Diagnoses

C44.511 - Basal cell carcinoma of skin of breast
- Indicates a malignant skin tumor on the breast, relevant for patients requiring breast reconstruction after cancer removal.
C44.521 - Squamous cell carcinoma of skin of breast
- Represents a different type of skin cancer on the breast, also leading to reconstructive needs.
C44.591 - Other specified malignant neoplasm of skin of breast
- Covers other malignant skin tumors of the breast, necessitating reconstructive surgery.
C50.011 - Malignant neoplasm of nipple and areola, right female breast
- Indicates cancer in the nipple/areola area, right female breast, often requiring mastectomy and reconstruction.
C50.012 - Malignant neoplasm of nipple and areola, left female breast
- Cancer in the nipple/areola area, left female breast, relevant for reconstructive procedures.
C50.021 - Malignant neoplasm of nipple and areola, right male breast
- Cancer in the nipple/areola area, right male breast, may require similar reconstructive approaches.
C50.022 - Malignant neoplasm of nipple and areola, left male breast
- Cancer in the nipple/areola area, left male breast, relevant for reconstruction.
C50.111 - Malignant neoplasm of central portion of right female breast
- Cancer in the central area of the right female breast, leading to tissue removal and reconstruction.
C50.112 - Malignant neoplasm of central portion of left female breast
- Cancer in the central area of the left female breast, necessitating reconstructive surgery.
C50.121 - Malignant neoplasm of central portion of right male breast
- Cancer in the central area of the right male breast, relevant for reconstructive procedures.
C50.122 - Malignant neoplasm of central portion of left male breast
- Cancer in the central area of the left male breast, may require reconstruction.
C50.211 - Malignant neoplasm of upper‑inner quadrant of right female breast
- Cancer in the upper-inner quadrant, right female breast, often leading to partial or total mastectomy and reconstruction.
C50.212 - Malignant neoplasm of upper‑inner quadrant of left female breast
- Cancer in the upper-inner quadrant, left female breast, relevant for reconstructive surgery.
C50.221 - Malignant neoplasm of upper‑inner quadrant of right male breast
- Cancer in the upper-inner quadrant, right male breast, may require reconstruction.
C50.222 - Malignant neoplasm of upper‑inner quadrant of left male breast
- Cancer in the upper-inner quadrant, left male breast, relevant for reconstructive procedures.
C50.311 - Malignant neoplasm of lower‑inner quadrant of right female breast
- Cancer in the lower-inner quadrant, right female breast, leading to reconstructive needs.
C50.312 - Malignant neoplasm of lower‑inner quadrant of left female breast
- Cancer in the lower-inner quadrant, left female breast, relevant for reconstruction.
C50.321 - Malignant neoplasm of lower‑inner quadrant of right male breast
- Cancer in the lower-inner quadrant, right male breast, may require reconstructive surgery.
C50.322 - Malignant neoplasm of lower‑inner quadrant of left male breast
- Cancer in the lower-inner quadrant, left male breast, relevant for reconstruction.
C50.411 - Malignant neoplasm of upper‑outer quadrant of right female breast
- Cancer in the upper-outer quadrant, right female breast, often leading to reconstructive procedures.
C50.412 - Malignant neoplasm of upper‑outer quadrant of left female breast
- Cancer in the upper-outer quadrant, left female breast, relevant for breast reconstruction.

Related CPT Codes

19340 - Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
- Used when a permanent breast prosthesis is placed immediately after breast tissue removal or reconstruction, rather than using a tissue expander.
19342 - Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction
- Used when the permanent prosthesis is placed at a later stage, often after tissue expansion with a procedure like 19357.
19350 - Nipple/areola reconstruction
- Performed after breast mound reconstruction, often following procedures like 19357 and prosthesis placement.
11970 - Replacement of tissue expander with permanent prosthesis
- Used in the second stage of reconstruction, after the tissue expander placed with 19357 has achieved adequate expansion.
11971 - Removal of tissue expander(s) without insertion of prosthesis
- Used when the tissue expander is removed without placing a permanent prosthesis, such as in cases of complications or patient preference.

Codes 19340, 19342, 11970, and 11971 are commonly used in sequence or as alternatives depending on the reconstruction plan. 19350 is often used in the final stage of breast reconstruction.

National Reimbursement Benchmarks

Medicare's national mean rate for CPT code 19357 is $1,096.84, which is notably lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) average commercial mean rate of $1,707.82. Among commercial payers, UnitedHealth Group has the highest mean rate at $2,481.92, while Aetna is the lowest at $1,355.43.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $93.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group shows the widest dispersion at $1,432.00, reflecting greater variability in rates. Cigna and BUCA also display substantial ranges, while Aetna and Blue Cross Blue Shield are more moderate.

The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 19357 are notably higher than national averages across all major payers. The mean rates for commercial payers such as Aetna, UnitedHealth Group, and Blue Cross Blue Shield are substantially above their respective national benchmarks, with Aetna and UnitedHealth Group leading the pack. Medicare rates in Alaska, while slightly below the national mean, remain consistent with the national percentile spread.

The rate spread, calculated as the difference between the 75th and 25th percentiles, varies by payer. Blue Cross Blue Shield exhibits the widest spread at $1,076.93, indicating significant variability in reimbursement. In contrast, Aetna's rates are uniform across percentiles, suggesting standardized pricing. The table and chart below present the full breakdown of payer-specific rates in Alaska.

Key Insights for Alaska

Aetna is the highest paying payer in Alaska for CPT 19357, with a mean rate of $4,813.94, while Medicare is the lowest at $1,072.32.
All commercial payers in Alaska reimburse significantly above their respective national averages, with UnitedHealth Group and Aetna showing the largest deviations.
The rate spread between the 25th and 75th percentiles is widest for Aetna ($0, as all percentiles are equal), and most pronounced for Blue Cross Blue Shield ($1,076.93), indicating greater variability among BCBS rates.

CPT 19368: TRAM Flap Breast Reconstruction with Microvascular Anastomosis

CPT-19328-BREAST-IMPLANT-REMOVAL-EXPLANTATION

CPT 19328: Removal of Previously Placed Breast Implant

19316-MASTOPEXY-INCLUDING-AUGMENTATION-WHEN-PERFORMED-WITH

CPT 19316: Mastopexy with Implant (Breast Lift and Augmentation)

CPT-19355-INVERTED-NIPPLE-CORRECTION

CPT 19355: Correction of Inverted Nipple

CPT-19370-BREAST-CAPSULE-RELEASE-CAPSULECTOMY

CPT 19370: Surgical Release of Breast Implant Capsule

CPT-19350-NIPPLE-AREOLAR-RECONSTRUCTION-LOCAL-FLAP-TECHNIQUES

CPT 19350: Nipple and Areolar Reconstruction

CPT-19342-BREAST-IMPLANT-INSERTION-OR-REPLACEMENT-POST-MASTECTOMY

CPT 19342: Breast Implant Insertion or Replacement After Mastectomy

CPT-19330-BREAST-IMPLANT-EXPLANTATION-RUPTURE

CPT 19330: Removal of Ruptured Breast Implant Material

19318-REDUCTION

CPT 19318: Reduction Mammoplasty

CPT-19367-PEDICLED-TRAM-FLAP-BREAST-RECONSTRUCTION

CPT 19367: Pedicled TRAM Flap Breast Reconstruction

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