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CPT 19357: Breast Tissue Expander Placement with Serial Expansion
CPT code 19357 denotes surgical placement of a tissue expander under the skin and pectoralis major muscle to prepare the breast for a permanent implant, typically after mastectomy. The code covers the initial insertion and the planned series of expansions that occur over subsequent weeks. This service is a common component of staged breast reconstruction and has implications for surgical workflow, device management, and payer coverage policy nationwide.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common related procedural coding. The publication summarizes how 19357 relates to other reconstructive and expander-related procedures and identifies typical clinical indications tied to malignant and selected cutaneous diagnoses of the breast.
The report highlights benchmarks and operational considerations for billing and coding teams, clarifies clinical scenarios where tissue expanders are utilized, and provides references to closely related CPT codes for reconstruction and subsequent device replacement or removal. Policy updates and payer-specific coverage language are summarized where available. Data not available in the input is explicitly noted in relevant sections of the full publication.
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Billing Code Overview
CPT code 19357 describes the placement of a tissue expander beneath the skin and the pectoralis major muscle of the chest to increase breast size and create space for a future permanent implant. The procedure commonly follows mastectomy or other breast surgery and includes the planned serial expansions performed over a period of weeks to achieve the desired pocket volume.
Service type: Breast reconstruction — tissue expander placement with serial expansion
Typical site of service: Hospital outpatient surgical suite or ambulatory surgery center (same‑day or short observation)
National Reimbursement Benchmarks
Medicare’s mean rate of $1,096.80 sits well below BUCA’s mean commercial rate of $4,685.60, indicating Medicare reimburses substantially less on average for CPT 19357 than the aggregated commercial BUCA cohort. That gap of $3,588.80 highlights a clear separation between government and commercial average pricing for this code.
Dispersion measured as the interquartile difference (P75−P25) is smallest for Aetna at $1,305.70 and for Medicare at $93.00, indicating the tightest mid‑range concentration. The widest IQRs are with Blue Cross Blue Shield at $7,852.30 and BUCA at $5,097.70, reflecting much greater variability in commercial negotiated rates; UnitedHealth Group ($1,493.80) and Cigna ($1,426.80) fall in between those extremes.