CPT 19330: Removal of Ruptured Breast Implant Material

CPT code 19330 represents the surgical removal of breast implant material in the setting of implant rupture. This code is used when explantation is performed to remove the implant and any associated leaked material, a clinically important intervention to address device failure, local inflammation, pain, or potential silicone migration. Nationally, explantation procedures for ruptured implants have implications for surgical utilization, device surveillance, and payer coverage policies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how this service is classified, typical sites of service, and common clinical scenarios that prompt coding of 19330. The publication summarizes benchmark utilization metrics where available, typical billing practices, and relevant policy developments affecting coverage and prior authorization requirements.

The content provides practical context for coding and claims professionals, surgical teams, and policy analysts by outlining clinical indications, service settings, and payer considerations tied to explantation for ruptured breast implants. Data not available in the input is noted where applicable, and the focus remains on national-level implications rather than state-specific rules.

Billing Code Overview

CPT code 19330 describes the surgical removal of breast implant material when an implant has ruptured. This procedure involves explantation of the implant and any associated free silicone or saline material as indicated by the rupture.

Service type: Surgical explantation related to implant rupture
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical Context

A typical patient is a woman with a ruptured breast implant presenting to a breast surgeon or plastic surgeon's clinic with breast pain, changes in breast shape, or imaging evidence of implant rupture (eg, MRI or ultrasound). The clinical workflow begins with outpatient evaluation, history and physical exam, and imaging confirmation. Once rupture is confirmed, the surgeon schedules an operative procedure to remove the implant material and any gross silicone or saline, often with capsulectomy if indicated. The procedure may be performed under general anesthesia in an ambulatory surgical center or hospital operating room depending on patient comorbidities and concurrent procedures. Preoperative documentation should include informed consent, imaging results, laterality, implant type, and planned intraoperative steps. Postoperative care includes wound care instructions, pathology if capsule tissue is sent, and follow-up for pain control and assessment for reconstruction or replacement if planned.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work required to remove implant material is substantially greater than typical (extensive adhesions, complex capsulectomy).
`26`	Professional component

Taxonomy Code	Specialty	Notes
207P00000X	Plastic Surgery	Most commonly performs implant removal and capsulectomy and manages reconstruction options.
207PR0200X	Plastic and Reconstructive Surgery - Breast	Subspecialty focus on breast reconstruction and implant management.
207L00000X	General Surgery	May perform implant removal when breast surgical pathology or access is required.
208000000X	Obstetrics & Gynecology	Some gynecologic-oncoplastic or cosmetic breast surgeons within this taxonomy may perform implant work in certain practices.
163W00000X	Radiology	Involved preoperatively for imaging diagnosis (MRI/ultrasound) though not performing the removal procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M24.511`	Adhesive capsulitis of right shoulder	Data not available in the input.
`M24.512`	Adhesive capsulitis of left shoulder	Data not available in the input.
`N63`	Unspecified lump in breast	Data not available in the input.
`T85.49`	Other complications of internal prosthetic devices, implants and grafts of breast	Relevant to implant rupture and complications requiring removal.
`T85.42`	Mechanical complication of breast prosthesis	Directly relevant to reporting mechanical failure or rupture of an implant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19325`	Mammaplasty, augmentation; with prosthetic implant	Performed when replacement augmentation is done after removal of a ruptured implant; may be performed during the same operative episode or deferred.
`19328`	Removal of intact mammary implant	Used when the implant is removed intact without rupture; may be reported instead when rupture is not present.
`19331`	Removal of ruptured mammary implant with microvascular flap reconstruction	Used when implant removal is accompanied by complex reconstructive procedures such as flap reconstruction.
`19340`	Immediate or delayed introduction of tissue expanders, breast	May be performed if tissue expander placement is planned following implant removal as part of staged reconstruction.
`19000`	Puncture aspiration of cyst of breast	Performed preoperatively for diagnostic/therapeutic aspiration if coexisting breast fluid collection is present prior to definitive implant removal.

OpenPayer

Summary & Overview