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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.
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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
National Reimbursement Benchmarks
Medicare’s mean allowed amount of $742.8 sits well below BUCA’s average commercial mean of $2,740.9, indicating a sizeable gap between federal reimbursement and average commercial contracting levels for CPT 19316. That differential of $1,998.1 highlights how commercial payers on average pay materially more than Medicare for this service, with BUCA nearer to upper-commercial territory while Medicare remains closer to a tighter federal band.
Dispersion across payers varies: Blue Cross Blue Shield shows the widest interquartile spread (P75–P25 = $4,518.50), reflecting substantial variability in negotiated commercial rates, while Aetna’s spread of $667.20 and Cigna’s $890.60 are comparatively tighter. UnitedHealth Group’s spread is $851.70, placing it between the tightest and widest payers. BUCA’s IQR is $2,928.00 and Medicare’s IQR is $62.00, with Medicare the tightest and BCBS the most dispersed.