Summary & Overview
CPT 19316: Mastopexy (Breast Lift)
CPT code 19316 represents a mastopexy (breast lift), a common plastic surgery procedure to remove excess breast skin and tighten surrounding tissue for reshaping and repositioning the breast. Mastopexy is clinically significant nationally because it is performed for both aesthetic and reconstructive indications, often following weight changes, aging, or oncologic surgery. Payment classification and coding affect surgical planning, site-of-service decisions, and claims adjudication across major payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage and billing considerations for this procedure across those payers, clarification of typical service settings, and clinical context that aligns coding to common diagnoses. The publication summarizes benchmark considerations and policy-relevant points that influence utilization and claim processing for mastopexy services.
This summary is intended for providers, billing professionals, and policy analysts seeking an authoritative reference on CPT code 19316, including what the code denotes, where the procedure is typically performed, and which national payers are relevant to coverage and reimbursement discussions.
Billing Code Overview
CPT code 19316 describes a mastopexy (breast lift) procedure. The service involves removal of excess breast skin and tightening of surrounding breast tissue to reshape and reposition the breast.
Service Type: Breast reconstructive/plastic surgery procedure
Typical Site of Service: Ambulatory surgical center or hospital outpatient surgical unit
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to a plastic surgery clinic with symptomatic breast ptosis following weight loss and prior lumpectomy for a malignancy of the central portion of the right breast. After oncologic treatment and clearance, the patient requests a mastopexy to improve breast shape and nipple-areola position. Preoperative workup includes history and physical, review of prior pathology and imaging, mammography if indicated, discussion of surgical options, informed consent, and preoperative medical evaluation. On the day of surgery the patient receives general anesthesia in an ambulatory surgical center or hospital outpatient department. The surgeon performs a 19316 mastopexy, excising redundant skin, reshaping the breast parenchyma, and repositioning the nipple-areolar complex. Specimens from any suspicious skin or prior scar area are submitted for pathology if clinically warranted. Postoperative care includes dressings, surgical drains if placed, recovery monitoring, discharge instructions, and scheduled follow-up visits for wound check and suture removal. Typical sites of service are an ambulatory surgical center or hospital outpatient surgical suite.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When mastopexy is performed on both breasts during the same operative session |