Find policies, billing codes, payers, states, and providers

CPT 19355: Correction of Inverted Nipple

CPT code 19355 represents a minor reconstructive breast surgery used to correct inverted nipples by releasing ducts and fibrous attachments. This procedure is relevant across outpatient surgical settings and ambulatory surgery centers and has implications for plastic and reconstructive surgeons, breast specialists, and surgical billing teams. Nationally, accurate coding of this procedure affects procedure reporting, quality measurement, and claims processing for breast reconstruction and aesthetic/restorative breast care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, common billing context, and an overview of coding considerations relevant to provider offices and billing departments. The publication outlines typical sites of service and service type, clarifies the procedural intent, and identifies common modifiers and payer relationships where available. Where specific data elements are not provided in the input, the report notes that data is not available in the input.

This summary equips clinicians, coding professionals, and policy analysts with the essential context needed to understand CPT code 19355, its clinical role in nipple reconstruction, and the payer landscape for national-level discussion of coding and reimbursement practices.

Customize your policy alerts

Sign up for cpt 19355 policy alerts

Get alerted when payer policies referencing 19355 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 19355 describes a surgical procedure for correction of inverted nipples by releasing the ducts and supporting fibers that hold the nipple inward. The procedure focuses on freeing the tethering structures to allow projection of the nipple.

Service type: Minor reconstructive breast surgery
Typical site of service: Outpatient surgical suite or ambulatory surgery center

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

CPT 19355: Correction of Inverted Nipple

Customize your policy alerts

Sign up for cpt 19355 policy alerts

Get alerted when payer policies referencing 19355 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Minor reconstructive breast surgery
Typical site of service: Outpatient surgical suite or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 28-year-old female presents to a plastic surgery clinic with symptomatic bilateral inverted nipples that interfere with breastfeeding and cause recurrent mastitis. After evaluation, conservative measures (e.g., suction devices, noninvasive traction) were attempted without durable improvement. The surgeon schedules a local procedure under local anesthesia with sedation or short general anesthesia to release the lactiferous ducts and fibrous bands tethering the nipple, correct inversion, and preserve as much ductal tissue as possible for future lactation.

Preoperative workflow includes informed consent documenting goals and risks, targeted breast exam, photographic documentation, and markup of operative sites. On the day of service, the procedure is typically performed in an outpatient ambulatory surgery center or hospital outpatient department; start and stop times, operative findings (degree of inversion, unilateral vs bilateral), and any intraoperative complications are documented. Postoperative instructions cover wound care, breastfeeding guidance, and follow-up visits for wound check and assessment of nipple projection and sensation.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, uncomplicated service	Use for the primary procedure when no unusual circumstances altered performance.
`22`	Increased procedural services	Use when documentation supports substantially greater work or time than typical for `19355`.
`52`	Reduced services	Use when the service is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances.
`50`	Bilateral procedure	Use when `19355` is performed on both nipples and payer requires a bilateral modifier instead of bilateral CPT modifier convention.
`RT`	Right side	Use to identify the right nipple when reporting laterality instead of modifier `50`.
`LT`	Left side	Use to identify the left nipple when reporting laterality instead of modifier `50`.
`63`	Procedure performed on infants less than 4 kg	Use when patient size/age meets the modifier's criteria if applicable.
`23`	Unusual anesthesia	Use when local anesthesia with monitored anesthesia care requires reporting of unusual anesthesia circumstances.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207P00000X`	Plastic Surgery	Surgeons who commonly perform nipple inversion release and aesthetic/breast-conserving procedures.
`207L00000X`	General Surgery	General surgeons with breast specialty experience may perform this procedure.
`207K00000X`	Obstetrics & Gynecology	OB/GYN providers may perform nipple release in lactation-related cases.
`363A00000X`	Family Medicine	Family physicians with minor procedure skills may manage simple cases or initial referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N64.89`	Other specified disorders of breast	Captures nipple inversion and other noninfectious structural breast issues when a more specific code is not applicable.
`N64.3`	Galactorrhea	Relevant when abnormal nipple discharge accompanies inversion and requires evaluation before corrective procedures.
`N61`	Inflammatory disorders of breast	Used when mastitis or recurrent infection is present in association with inverted nipples.
`L98.9`	Disorder of skin and subcutaneous tissue, unspecified	May apply when areolar or periareolar skin conditions contribute to inversion.
`Z41.2`	Encounter for routine checking of plastic and cosmetic surgery status	Used for preoperative or postoperative assessment in cosmetic correction contexts.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19316`	Mastopexy, augmentation with implant	Performed when correction of nipple inversion is combined with breast lift and augmentation planning in more extensive reconstructive cases.
`19000`	Puncture aspiration of cyst, or similar lesion	May be performed preoperatively for diagnostic relief if a subareolar abscess or cyst contributes to inversion or infection.
`12032`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.5 cm to 7.5 cm	Example code for intermediate closures; minor revisions of the nipple-areolar complex may require appropriate closure coding depending on repair complexity.
`11100`	Biopsy of single skin lesion	Used when a suspicious areolar lesion requires pathologic diagnosis prior to definitive correction.
`99213`	Office/outpatient visit, est. patient, 15 minutes	Typical preoperative or postoperative office visit level commonly reported during the care episode.
`99024`	Postoperative follow-up visit global period excluded	Used to report an unrelated postoperative visit occurring during the global period of `19355`.

Related Codes

CPT-19316-MASTOPEXY-BREAST-LIFT

CPT 19316: Mastopexy (Breast Lift)

CPT-19318-BREAST-REDUCTION-SURGERY

CPT 19318: Breast Reduction Surgery

CPT-19325-BREAST-AUGMENTATION-IMPLANT-PLACEMENT

CPT 19325: Breast Augmentation by Implant Placement

CPT-19328-BREAST-IMPLANT-REMOVAL-EXPLANTATION

CPT 19328: Removal of Previously Placed Breast Implant

CPT-19330-BREAST-IMPLANT-EXPLANTATION-RUPTURE

CPT 19330: Removal of Ruptured Breast Implant Material

CPT-19340-IMMEDIATE-BREAST-IMPLANT-INSERTION-AFTER-MASTECTOMY

CPT 19340: Immediate Insertion of Breast Implant Following Mastectomy

CPT-19342-BREAST-IMPLANT-INSERTION-OR-REPLACEMENT-POST-MASTECTOMY

CPT 19342: Breast Implant Insertion or Replacement After Mastectomy

CPT-19350-NIPPLE-AREOLAR-RECONSTRUCTION-LOCAL-FLAP-TECHNIQUES

CPT 19350: Nipple and Areolar Reconstruction

CPT-19357-BREAST-TISSUE-EXPANDER-PLACEMENT-SERIAL-EXPANSION

CPT 19357: Breast Tissue Expander Placement with Serial Expansion

CPT-19361-LATISSIMUS-DORSI-BREAST-RECONSTRUCTION-FLAP

CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap

Showing 1–10 of 18

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, uncomplicated service	Use for the primary procedure when no unusual circumstances altered performance.
`22`	Increased procedural services	Use when documentation supports substantially greater work or time than typical for `19355`.
`52`	Reduced services	Use when the service is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances.
`50`	Bilateral procedure	Use when `19355` is performed on both nipples and payer requires a bilateral modifier instead of bilateral CPT modifier convention.
`RT`	Right side	Use to identify the right nipple when reporting laterality instead of modifier `50`.
`LT`	Left side	Use to identify the left nipple when reporting laterality instead of modifier `50`.
`63`	Procedure performed on infants less than 4 kg	Use when patient size/age meets the modifier's criteria if applicable.
`23`	Unusual anesthesia	Use when local anesthesia with monitored anesthesia care requires reporting of unusual anesthesia circumstances.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207P00000X`	Plastic Surgery	Surgeons who commonly perform nipple inversion release and aesthetic/breast-conserving procedures.
`207L00000X`	General Surgery	General surgeons with breast specialty experience may perform this procedure.
`207K00000X`	Obstetrics & Gynecology	OB/GYN providers may perform nipple release in lactation-related cases.
`363A00000X`	Family Medicine	Family physicians with minor procedure skills may manage simple cases or initial referral.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N64.89`	Other specified disorders of breast	Captures nipple inversion and other noninfectious structural breast issues when a more specific code is not applicable.
`N64.3`	Galactorrhea	Relevant when abnormal nipple discharge accompanies inversion and requires evaluation before corrective procedures.
`N61`	Inflammatory disorders of breast	Used when mastitis or recurrent infection is present in association with inverted nipples.
`L98.9`	Disorder of skin and subcutaneous tissue, unspecified	May apply when areolar or periareolar skin conditions contribute to inversion.
`Z41.2`	Encounter for routine checking of plastic and cosmetic surgery status	Used for preoperative or postoperative assessment in cosmetic correction contexts.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19316`	Mastopexy, augmentation with implant	Performed when correction of nipple inversion is combined with breast lift and augmentation planning in more extensive reconstructive cases.
`19000`	Puncture aspiration of cyst, or similar lesion	May be performed preoperatively for diagnostic relief if a subareolar abscess or cyst contributes to inversion or infection.
`12032`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.5 cm to 7.5 cm	Example code for intermediate closures; minor revisions of the nipple-areolar complex may require appropriate closure coding depending on repair complexity.
`11100`	Biopsy of single skin lesion	Used when a suspicious areolar lesion requires pathologic diagnosis prior to definitive correction.
`99213`	Office/outpatient visit, est. patient, 15 minutes	Typical preoperative or postoperative office visit level commonly reported during the care episode.
`99024`	Postoperative follow-up visit global period excluded	Used to report an unrelated postoperative visit occurring during the global period of `19355`.

Related Codes

CPT-19316-MASTOPEXY-BREAST-LIFT

CPT 19316: Mastopexy (Breast Lift)

CPT-19318-BREAST-REDUCTION-SURGERY

CPT 19318: Breast Reduction Surgery

CPT-19325-BREAST-AUGMENTATION-IMPLANT-PLACEMENT

CPT 19325: Breast Augmentation by Implant Placement

CPT-19328-BREAST-IMPLANT-REMOVAL-EXPLANTATION

CPT 19328: Removal of Previously Placed Breast Implant

CPT-19330-BREAST-IMPLANT-EXPLANTATION-RUPTURE

CPT 19330: Removal of Ruptured Breast Implant Material

CPT-19340-IMMEDIATE-BREAST-IMPLANT-INSERTION-AFTER-MASTECTOMY

CPT 19340: Immediate Insertion of Breast Implant Following Mastectomy

CPT-19342-BREAST-IMPLANT-INSERTION-OR-REPLACEMENT-POST-MASTECTOMY

CPT 19342: Breast Implant Insertion or Replacement After Mastectomy

CPT-19350-NIPPLE-AREOLAR-RECONSTRUCTION-LOCAL-FLAP-TECHNIQUES

CPT 19350: Nipple and Areolar Reconstruction

CPT-19357-BREAST-TISSUE-EXPANDER-PLACEMENT-SERIAL-EXPANSION

CPT 19357: Breast Tissue Expander Placement with Serial Expansion

CPT-19361-LATISSIMUS-DORSI-BREAST-RECONSTRUCTION-FLAP

CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap

Showing 1–10 of 18

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.