CPT 19318: Breast Reduction—Excision of Excess Breast Tissue
Medicare pays $997 and commercial payers pay $3240 on average nationally for this procedure.
CPT code 19318 describes surgical breast reduction involving removal of excess breast tissue and reshaping of the breast due to scarring, calcification, or architectural distortion; this is a breast reduction/excisional procedure typically performed as an operative surgical procedure in an outpatient surgical center or hospital operating room setting under general anesthesia.
For related coverage guidance, see recent payer policy updates: Removal of Implantable, Outpatient Surgical Procedures - Site of Service, Surgical Procedures.
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National Reimbursement Benchmarks
Nationwide averages place Medicare substantially lower than BUCA’s commercial average: Medicare’s mean is $997.40 versus BUCA’s mean of $3,239.60, a gap of $2,242.20 that highlights a sizeable differential between government and commercial payment levels for CPT 19318. Other major commercial payers fall between these points, with Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealth Group showing higher means than Medicare but varying widely among themselves.
Looking at dispersion using the interquartile range (P75–P25), Blue Cross Blue Shield exhibits the widest spread at $5,932.60, indicating the greatest variability in market rates. Aetna’s IQR is $1,215.00 and BUCA’s IQR is $3,342.10; UnitedHealth Group and Cigna have moderate spreads of $1,196.10 and $1,255.20 respectively, making UnitedHealth Group the tightest among the listed commercial payers by this measure.