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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.
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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.
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Service type: Breast reconstruction with pedicled latissimus dorsi flap
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Typical site of service: Inpatient or outpatient surgical setting (operating room), often within hospital or ambulatory surgery center environments
National Reimbursement Benchmarks
Commercial averages are generally above Medicare for CPT 19361: Blue Cross Blue Shield, Cigna, UnitedHealth Group, Aetna and BUCA show mean rates well above Medicare’s mean of $1,404.90, with BUCA’s mean at $2,122.10 representing the average commercial level that is roughly $717.20 higher than Medicare. This gap highlights that Medicare remains a lower baseline payer for this code compared with major commercial plans.
Dispersion differs notably by payer. Calculating P75 minus P25, Aetna’s interquartile spread is $1,264.00, Blue Cross Blue Shield’s is $1,355.50, Cigna’s is $1,812.80, UnitedHealth Group’s is $1,721.60, and BUCA’s is $1,460.30. Cigna shows the widest IQR, indicating the greatest middle-range variability, while Aetna is the tightest of the listed commercial payers on an IQR basis.