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CPT 19340: Immediate Insertion of Breast Implant Following Mastectomy
CPT code 19340 denotes immediate insertion of a breast implant at the time of mastectomy and is a primary code for implant-based breast reconstruction. Nationally, this procedure is integral to breast cancer surgical care and reconstructive planning, affecting surgical practice patterns, facility utilization, and payer coverage policy. The code captures a single-stage approach to reconstruction when the implant is placed during the mastectomy operation.
This summary addresses payer coverage considerations for major national plans: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for immediate implant placement, common related procedure codes, and the coding boundaries that differentiate immediate insertion from delayed or staged reconstructions. The content highlights typical sites of service and service type, and orients clinicians, coders, and administrators to where this code fits among alternatives such as tissue expanders or delayed implant procedures.
Audience members will learn practical benchmarks and policy-relevant points about use of CPT code 19340, including typical clinical scenarios that generate the code and how it relates to other reconstruction options. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 19340 describes the procedure in which the physician immediately inserts a breast implant following a mastectomy (breast excision). This code represents an immediate implant-based breast reconstruction performed at the same operative session as the mastectomy.
Service Type: Breast reconstruction, immediate implant insertion
Typical Site of Service: Hospital operating room or ambulatory surgical center
National Reimbursement Benchmarks
National commercial averages sit well above Medicare for CPT 19340: Blue Cross Blue Shield and BUCA averages (BCBS mean $4,306; BUCA mean $2,947.90) are roughly six and four times Medicare’s mean of $714.80 respectively, while other large commercial payers fall between those extremes. This spread highlights that commercial contracting produces substantially higher average allowed amounts than Medicare for this code.
Dispersion measured by the interquartile range (P75−P25) varies notably by payer. Blue Cross Blue Shield shows the widest IQR at $6,759.90−$753.20 = $6,006.70, followed by UnitedHealth Group with an IQR of $1,975.80−$928.10 = $1,047.70. The tightest distributions are Aetna (IQR $850.20−$133.20 = $717.00) and Cigna (IQR $1,669.90−$711.00 = $958.90), indicating different levels of price concentration across commercial markets.