Summary & Overview
CPT 19364: Free Flap Breast Reconstruction
CPT code 19364 denotes autologous free flap breast reconstruction, where skin, muscle, and/or fat are harvested from a donor site (such as inner thigh, buttock, or lower abdomen) and transferred to recreate the breast contour after modified or radical mastectomy or to repair a defect. This reconstructive technique is clinically significant for restoring form and symmetry after oncologic breast surgery and for addressing complex soft-tissue defects.
Major national payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and coding guidance for this procedure affect hospital and surgical practice revenue cycles, medical necessity determinations, and patient access to reconstructive options.
Readers will find a concise overview of the clinical context for autologous free flap reconstruction, payer coverage considerations, common coding interactions, and related service-reporting issues. The publication highlights relevant billing relationships (including procedures not reportable separately with 19364) and typical sites of service. It is intended to inform coding, billing, and administrative staff, as well as clinicians and surgical program managers, about documentation and coding context for this reconstructive procedure at a national level.
Billing Code Overview
CPT code 19364 describes reconstruction of the breast contour using a free flap of skin and muscle and/or fat harvested from another anatomic site and transferred to the breast to restore cosmetic appearance after a modified or radical mastectomy or to repair a defect. This procedure is a type of breast reconstruction using a free flap technique.
-
Service type: Autologous free flap breast reconstruction (harvest and transfer of skin, muscle, and/or fat)
-
Typical site of service: Hospital-based operating room or ambulatory surgery center for reconstructive breast surgery
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left breast |
RT |