Summary & Overview

CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap

CPT code 19361 denotes breast reconstruction using a flap of tissue and muscle harvested from behind the shoulder (latissimus dorsi flap) to recreate breast contour after modified or radical mastectomy or to repair a defect. This reconstructive procedure is an important component of breast cancer care pathways and post‑mastectomy restorative services, affecting coverage, surgical planning, and patient access to reconstructive options nationwide. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.

Readers will find a concise overview of the clinical intent of CPT code 19361, how it relates to other flap and reconstruction codes, common diagnostic contexts for use, and typical sites of service. The publication also summarizes payer coverage considerations, common administrative modifiers encountered on claims, and related surgical codes used for alternative reconstruction approaches. This information aids revenue cycle, surgical planning, and compliance teams in aligning coding choices with clinical documentation and payer policies. Data not available in the input regarding utilization benchmarks or payer-specific reimbursement rates is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicare19361CPTbreast reconstructionlatissimus dorsi flapmastectomyplastic surgeryreconstructive surgerysurgical coding

Billing Code Overview

CPT code 19361 describes surgical reconstruction of the breast using a flap of tissue and muscle harvested from behind the shoulder (a latissimus dorsi flap) that is sutured at the mastectomy site to recreate breast contour. The procedure is performed to restore cosmetic appearance following a modified or radical mastectomy or to repair a post‑surgical defect.

Service type: Breast reconstruction with pedicled latissimus dorsi flap
Typical site of service: Inpatient or outpatient surgical setting (operating room), often within hospital or ambulatory surgery center environments

Clinical & Coding Specifications

Clinical Context

A 52-year-old woman with a history of left modified radical mastectomy for invasive ductal carcinoma presents for delayed autologous breast reconstruction. The surgical plan is a pedicled latissimus dorsi flap harvested from the parascapular/latissimus region and tunneled to the mastectomy site to recreate breast contour and provide soft-tissue coverage, coded as 19361. Preoperative workflow includes oncology clearance, imaging review, consent documenting risks and expectations, and marking of donor and recipient sites. Intraoperative workflow includes general anesthesia, positioning for simultaneous chest and back access, harvesting the muscle and overlying skin paddle, tunneling to the chest, shaping and suturing the flap to the chest wall, and hemostasis. Postoperative workflow includes PACU monitoring, pain control, flap monitoring for perfusion, wound care instructions, and scheduled follow-up for drain removal and assessment of reconstruction integrity. This procedure is performed by plastic and reconstructive surgeons, often in coordination with surgical oncology when staged reconstruction follows cancer extirpation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing is split and only the surgeon's professional component is reported separate from technical facility charges

Taxonomy Code	Specialty	Notes
`208200000X`	Plastic and Reconstructive Surgery	Primary specialty performing autologous flap breast reconstruction procedures
`2086S0122X`	Surgical Oncology	Often involved for cancer extirpation, staging, and coordination of reconstruction timing
`208600000X`	Surgery	General surgeons may be involved in oncologic resection or coordinated care for complex cases

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C44.511`	Basal cell carcinoma of skin of breast	Malignancy of skin over the breast that may necessitate mastectomy or resection with subsequent reconstructive needs
`C44.521`	Squamous cell carcinoma of skin of breast	Skin malignancy affecting the breast requiring excision and possible reconstruction for defect repair
`C44.591`	Other specified malignant neoplasm of skin of breast	Less common skin malignancies of the breast that can produce defects requiring reconstructive flap coverage
`C50.011`	Malignant neoplasm of nipple and areola, right female breast	Primary breast cancer location that can lead to nipple–areolar resections and need for reconstructive flap to restore contour
`C50.012`	Malignant neoplasm of nipple and areola, left female breast	As above for left-sided disease requiring reconstruction post-resection
`C50.021`	Malignant neoplasm of nipple and areola, right male breast	Male breast cancer necessitating oncologic resection with possible reconstructive procedures to repair defects
`C50.022`	Malignant neoplasm of nipple and areola, left male breast	As above for left-sided male breast malignancy requiring reconstruction
`C50.111`	Malignant neoplasm of central portion of right female breast	Tumor involving central breast tissue that may require mastectomy and subsequent autologous reconstruction
`C50.112`	Malignant neoplasm of central portion of left female breast	As above for left central tumors leading to reconstructive needs
`C50.121`	Malignant neoplasm of central portion of right male breast	Central male breast tumors that can require resection and reconstructive repair
`C50.122`	Malignant neoplasm of central portion of left male breast	As above for left-sided central male breast tumor
`C50.211`	Malignant neoplasm of upper‑inner quadrant of right female breast	Quadrant-specific breast cancer location that may influence surgical approach and reconstruction planning
`C50.212`	Malignant neoplasm of upper‑inner quadrant of left female breast	As above for left upper‑inner quadrant disease

CPT Code	Description	Relationship to This Procedure
`19364`	Breast reconstruction with free flap	Alternative autologous reconstruction technique using microvascular free tissue transfer instead of a pedicled latissimus flap
`19367`	Breast reconstruction, single pedicled TRAM flap	Alternative pedicled autologous option using transverse rectus abdominis myocutaneous tissue for breast reconstruction
`19368`	Breast reconstruction, 1 pedicled TRAM flap, anastomosis	Related variation when additional microvascular anastomosis or complexity is involved with TRAM-based reconstruction
`19369`	Breast reconstruction, bipedicled TRAM flap	Alternative autologous technique using two pedicles for increased tissue volume or vascular support

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