Summary & Overview
CPT 19328: Removal of Previously Placed Breast Implant
CPT code 19328 represents the surgical removal (explantation) of a previously placed breast implant. This code is used to bill for procedures in which one or both implants are surgically removed, and it is relevant across reconstructive and cosmetic breast surgery contexts. Nationally, implant removal is an important component of plastic and reconstructive surgery practice, driven by complications, device failure, patient preference, or part of staged reconstruction.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for explantation, typical sites of service (ambulatory surgical centers and hospital operating rooms), and the common modifier landscape associated with surgical services. The publication outlines billing benchmarks, payer coverage considerations, and policy updates that affect authorization and coding for explantation procedures. Clinical context sections explain typical indications for removal and perioperative considerations relevant to coding and claims submission.
This summary provides practitioners, coding professionals, and policy analysts with a national perspective on how CPT code 19328 fits into surgical workflows, payer interactions, and administrative processes. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19328 describes the removal of a previously placed breast implant. The procedure involves explantation of one or more breast implants that were surgically inserted in a prior operation.
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Service type: Surgical removal of implant, reconstructive/plastic surgery procedure
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman with previously placed breast implants presenting for elective removal due to chronic pain, capsular contracture, implant rupture, infection, extrusion, or change in aesthetic goals. The patient undergoes preoperative evaluation including history, focused breast exam, imaging as indicated (mammography, ultrasound, or MRI), and informed consent discussing risks of explantation, potential need for capsulectomy, and reconstruction options. The procedure is performed in an operating room or ambulatory surgical center under monitored anesthesia care or general anesthesia. Intraoperative steps include exposure of the implant pocket, removal of the implant, and selective capsulectomy or capsulectomy as clinically indicated, irrigation, hemostasis, and wound closure. Postoperative care includes pain control, wound care instructions, follow-up for pathology if capsule removed, and counseling about reconstruction timing if desired.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated service | Use when the explantation is performed without unusual circumstances and represents a routine primary service. |
22 | Increased procedural services | Use when work, time, or complexity is substantially greater than typical for explantation (extensive capsulectomy, difficult dissection). |
23 | Unusual anesthesia | Use when general anesthesia is required for reasons unrelated to the procedure complexity (e.g., severe anxiety or inability to cooperate). |
50 | Bilateral procedure | Use when explantation is performed on both breasts during the same operative session. |
51 | Multiple procedures | Use when explantation is billed with additional distinct procedures performed in the same session. |
52 | Reduced services | Use when the explantation is partially performed or discontinued and the full service is not rendered. |
53 | Discontinued procedure | Use when the procedure is started but halted due to extenuating circumstances. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure when explantation is reported with another service that might be bundled. |
76 | Repeat procedure by same physician | Use if a second explantation is performed later the same day by the same physician (Note: 76 is not in the provided list; if unavailable, use 77/79 — see alternatives below). |
78 | Unplanned return to OR for related procedure during postoperative period | Use when a patient requires a return to the operating room for a complication related to the explantation. |
79 | Unrelated procedure by same physician during postoperative period | Use when a separate unrelated procedure is performed during the global period. |
LT | Left side | Use to specify the left breast when laterality is reported separately. |
RT | Right side | Use to specify the right breast when laterality is reported separately. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207V00000X | Plastic Surgery | Primary specialty performing breast explantation and capsulectomy. |
2084P0800X | General Surgery | General surgeons may perform explantation, particularly in reconstructive or oncologic contexts. |
363A00000X | Obstetrics & Gynecology | Some gynecologic or breast-focused OB/GYNs perform implant removal in outpatient settings. |
207K00000X | Cosmetic Surgery | Surgeons focused on cosmetic procedures commonly perform elective explantations. |
352600000X | Surgical Oncology | In cases of oncologic indication or implant-related complications, surgical oncologists may be involved. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
T85.498A | Other mechanical complication of other internal prosthetic devices, implants and grafts, initial encounter | Codes mechanical problems such as rupture, malposition, or deflation leading to explantation. |
T85.49XA | Other complication of internal prosthetic device, initial encounter | Used for non-specific implant complications prompting removal. |
T86.81 | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts | (Note: not breast-specific) Infections related to implants can necessitate removal; use the most specific infection code for breast implant infection. |
N64.4 | Mastodynia | Chronic breast pain related to implants may lead to explantation when conservative care fails. |
T85.39XA | Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter | Infection of breast implant requiring removal. |
Z98.890 | Other specified postprocedural states | History of breast implant placement; may be used in longitudinal records associated with explantation. |
M79.1 | Myalgia | Non-specific chest wall or musculoskeletal pain potentially associated with implants prompting removal. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19330 | Mastectomy, simple, complete | Performed when explantation is associated with oncologic resection or conversion to mastectomy. |
19328 | Removal of intact or ruptured breast implant | Primary procedure for removal of a previously placed breast implant. |
19340 | Immediate insertion of breast prosthesis following mastectomy | May be performed after explantation if immediate reconstruction is chosen. |
19342 | Delayed insertion of breast prosthesis following mastectomy | Used when implant placement is performed in a separate, delayed session after explantation. |
19316 | Mastopexy | Performed concurrently when explantation is combined with breast lift or contouring for aesthetic goals. |
11042 | Debridement; skin and subcutaneous tissue (deep) | May be used if explantation requires debridement for infection or compromised tissue. |