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    v1.0.30
    OpenPayerBilling CodesRepair and/or Reconstruction Procedures on the BreastCPT cpt-19364-free-flap-breast-reconstruction
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    CPT 19364: Free Flap Breast Reconstruction

    Medicare pays $2403 and commercial payers pay $3446 on average nationally for this procedure.

    CPT code 19364 describes a breast reconstruction procedure in which the surgeon creates the contour of the breast by harvesting a free flap of skin and muscle and/or fat from another site (for example, inner thigh, buttock, or lower abdomen) and suturing it to the chest after modified or radical mastectomy; service type: reconstructive surgery using a free autologous flap; typical site of service: inpatient or outpatient surgical suite or hospital operating room for reconstructive breast surgery following mastectomy.

    For related coverage guidance, see recent payer policy updates: Removal of Implantable, Outpatient Surgical Procedures - Site of Service, Surgical Procedures.

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    National Reimbursement Benchmarks

    Commercial averages sit notably above Medicare for CPT 19364. Blue Cross Blue Shield, Cigna, UnitedHealth Group and BUCA all have mean rates higher than Medicare’s $2403 average; BUCA’s mean of $3446.30 and the commercial cluster (Cigna $4550.50, UnitedHealth Group $4703.20) illustrate how Medicare’s $2403 sits well below the commercial midpoint. The comparison highlights a substantial gap between Medicare and average commercial reimbursements for this code.

    Dispersion varies meaningfully across payers. Calculated P75–P25 ranges: Aetna $2551.0, Blue Cross Blue Shield $1900.1, Cigna $310.6? Correction: use given values: Cigna P75 ($5857.0) minus P25 ($2746.4) = $3110.6, UnitedHealth Group $300? Correction: UnitedHealth Group P75 ($5908.9) minus P25 ($2881.1) = $3027.8, BUCA $479.4? Correction: BUCA P75 ($4354.0) minus P25 ($1955.6) = $2398.4. The tightest interquartile spread is Blue Cross Blue Shield at $1900.10 and the widest is Cigna at $3110.60, with UnitedHealth Group ($3027.80) and Aetna ($3051.0? compute: Aetna P75 $3052.1 - P25 $500.7 = $2551.1) occupying high-dispersion positions.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    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 using a free flap. The surgical plan is to harvest a musculocutaneous or fasciocutaneous flap (for example, from the lower abdomen or inner thigh) and microvascularly anastomose it to recipient vessels at the chest to recreate breast contour after oncologic resection. Preoperative workflow includes surgical oncology and plastic surgery coordination, preoperative imaging and mapping of donor vessels, medical clearance, and informed consent documenting reconstruction intent and laterality. Intraoperative workflow includes flap harvest, microsurgical transfer, vessel anastomosis, inset and shaping of the flap, and donor-site closure. Postoperative care involves monitoring perfusion in a specialized recovery or intensive care setting, pain control, anticoagulation per protocol, flap checks, and staged revisions as needed for symmetry. Typical sites of service are an inpatient hospital operating room or an ambulatory surgical center with microsurgical capability depending on complexity and payor rules.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    15734Muscle, myocutaneous, or fasciocutaneous flap; trunkFlap harvest code for trunk donor sites; not reportable separately with 19364 as noted in guidance

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208200000X
    2086S0122X
    208600000X
    2083A0300X
    183500000X
    333600000X
    367500000X
    2251E1300X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C44.511Basal cell carcinoma of skin of breast
    C44.521Squamous cell carcinoma of skin of breast
    C44.591Other specified malignant neoplasm of skin of breast
    C50.011Malignant neoplasm of nipple and areola, right female breast
    C50.012Malignant neoplasm of nipple and areola, left female breast
    C50.112Malignant neoplasm of central portion of left female breast
    C50.119Malignant neoplasm of central portion of unspecified female breast
    C50.211Malignant neoplasm of upper-inner quadrant of right female breast
    C50.212Malignant neoplasm of upper-inner quadrant of left female breast
    C50.411Malignant neoplasm of upper-outer quadrant of right female breast

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Removal of ImplantableBlue Cross Blue Shield - Rhode Island2026-10-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Surgical ProceduresUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Medical Necessity Guidelines Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01

    Related Codes

    CPT-19316-MASTOPEXY-BREAST-LIFT

    CPT 19316: Mastopexy (Breast Lift)

    CPT-19318-BREAST-REDUCTION-SURGERY

    CPT 19318: Breast Reduction—Excision of Excess Breast Tissue

    CPT-19325-BREAST-AUGMENTATION-IMPLANT-PLACEMENT

    CPT 19325: Breast Augmentation with Implant Placement

    CPT-19328-BREAST-IMPLANT-REMOVAL-EXPLANTATION

    CPT 19328: Removal of Previously Placed Breast Implant

    CPT-19330-BREAST-IMPLANT-EXPLANTATION-RUPTURE

    CPT 19330: Breast Implant Removal for Rupture

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

    CPT 19340: Immediate Insertion of Breast Implant After 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, Local Flap

    CPT-19355-INVERTED-NIPPLE-CORRECTION

    CPT 19355: Correction of Inverted Nipples by Duct Release

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

    CPT 19357: Tissue Expander Placement for Breast Reconstruction

    Showing 1–10 of 18

    Frequently Asked Questions

    References

    1. 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. 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. 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.
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