Summary & Overview
CPT 19350: Nipple and Areolar Reconstruction
CPT code 19350 covers surgical reconstruction of the nipple and areola using techniques such as nipple sharing, skate flap, C–v flap, or other local flaps. This procedure is an element of post-mastectomy and breast reconstruction care that addresses cosmetic and psychosocial outcomes for patients. Nationally, the code is relevant to surgical practices, hospital outpatient departments, and ambulatory surgical centers that provide reconstructive breast services.
Key payers included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for nipple-areolar reconstruction, typical sites of service, and the procedural techniques referenced by the code. The publication outlines common billing considerations, benchmarking approaches, and policy or coverage considerations relevant to payers and providers. It also summarizes typical modifiers used with surgical CPT coding and flags where input data was not available for specific items such as associated taxonomies or ICD-10 diagnoses.
This summary equips payers, surgical practices, coding professionals, and policy analysts with the clinical framing and billing context for CPT code 19350, supporting consistent documentation and coding workflows.
Billing Code Overview
CPT code 19350 describes nipple and areolar reconstruction following mastectomy or breast reconstruction. The description notes several surgical techniques including nipple sharing, skate flap, C–v flap, or local flap, indicating this is a reconstructive surgical procedure focused on restoring nipple-areolar complex form and contour.
Service type: Reconstructive breast surgery
Typical site of service: Outpatient surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 48-year-old female status post unilateral mastectomy for left breast invasive ductal carcinoma presents for staged breast reconstruction. After completion of reconstructive implant exchange and soft-tissue optimization, the patient is scheduled for nipple-areolar complex reconstruction to improve cosmetic symmetry. The procedure is performed in an ambulatory surgical center or hospital outpatient department under local anesthesia with sedation or short general anesthesia. Typical workflow: preoperative marking of the reconstructed breast, selection of technique (nipple sharing, skate flap, C–V flap, or local flap), intraoperative creation of a projecting nipple and areolar shaping, optional application of tattooing at a later visit for areolar pigmentation, postoperative dressing and brief recovery, with follow-up visits to assess viability and wound healing. Documentation should include indication (e.g., postmastectomy reconstruction), technique used, laterality, anesthesia, intraoperative findings, estimated blood loss, complications if any, and plan for staged tattooing if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional portion separate from a facility charge (rare for this procedure). |
50 | Bilateral procedure | Use when nipple reconstruction is performed on both breasts in the same operative session. |
51 | Multiple procedures | Use when other distinct procedures are performed the same day in addition to nipple reconstruction. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to patient safety or other valid reasons. |
58 | Staged or related procedure or service by same physician during postoperative period | Use when nipple reconstruction is planned as a staged part of the overall reconstruction and done during the global period. |
59 | Distinct procedural service | Use when a separate identifiable procedure is performed that is not normally included with nipple reconstruction. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons. |
76 | Repeat procedure by same physician | Use if the same physician repeats the procedure later the same day (note: 76 is not in provided list; not used) |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use for unplanned reoperation related to the initial nipple reconstruction. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
LT | Left side | Use to indicate left-sided procedure when laterality is required. |
RT | Right side | Use to indicate right-sided procedure when laterality is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Plastic Surgery | Primary specialty performing nipple and areolar reconstruction. |
| 207P00000X | General Surgery | General surgeons with breast reconstruction training may perform this procedure. |
| 208000000X | Dermatology | Dermatologic surgeons perform local flap and nipple reconstruction in select cases. |
| 3336C0001X | Nurse Practitioner | Advanced practice providers who may assist in perioperative management and follow-up. |
| 363L00000X | Physician Assistant | PAs commonly assist in outpatient perioperative care and documentation. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19357 | Tissue expander placement in breast reconstruction | Performed earlier during staged reconstruction to create pocket for implant prior to nipple reconstruction. |
19342 | Immediate insertion of breast prosthesis following mastectomy | May precede nipple reconstruction when implant-based reconstruction is used. |
19370 | Revision of reconstructed breast | Performed when contour adjustments or flap revisions are needed before nipple reconstruction. |
11920 | Tattooing, intradermal pigmentation, single or multiple sites, with local anesthesia | Often performed after surgical nipple reconstruction to recreate areolar pigmentation as a separate service. |
15734 | Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis (breast reconstruction context) | Used in autologous reconstruction sequences that precede or are associated with later nipple reconstruction. |