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.

Customize your policy alerts

Sign up for cpt 19364 policy alerts

Get alerted when payer policies referencing 19364 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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.

Explore openpayer tools

View all tools

CPT 19364: Free Flap Breast Reconstruction

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

Customize your policy alerts

Sign up for cpt 19364 policy alerts

Get alerted when payer policies referencing 19364 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

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 Code	Description	Relationship to This Procedure
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk	Flap harvest code for trunk donor sites; not reportable separately with `19364` as noted in guidance

Related Modifiers

10 rows

Modifier	Description	When to Use
50	Modifier –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…
62	Modifier 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…
59	Modifier 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…
76	Modifier -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…
78	CPT 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…
79	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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…
26	Modifier 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	Specialty	Notes
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
2083A0300X	Addiction Medicine (Preventive Medicine) Physician	A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recove…
183500000X	Pharmacist	An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is no…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
367500000X	Certified Registered Nurse Anesthetist	(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
2251E1300X	Clinical Electrophysiology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Clinical Electrophysiologic Physical …

Related ICD-10-CM Codes

28 rows

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

Showing 1–10 of 28

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.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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk	Flap harvest code for trunk donor sites; not reportable separately with `19364` as noted in guidance

Related Modifiers

10 rows

Modifier	Description	When to Use
50	Modifier –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…
62	Modifier 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…
59	Modifier 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…
76	Modifier -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…
78	CPT 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…
79	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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…
26	Modifier 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	Specialty	Notes
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
2083A0300X	Addiction Medicine (Preventive Medicine) Physician	A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recove…
183500000X	Pharmacist	An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is no…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
367500000X	Certified Registered Nurse Anesthetist	(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
2251E1300X	Clinical Electrophysiology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Clinical Electrophysiologic Physical …

Related ICD-10-CM Codes

28 rows

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

Showing 1–10 of 28

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.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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 19364: Free Flap Breast Reconstruction

Sign up for cpt 19364 policy alerts

National Reimbursement Benchmarks

CPT 19364: Free Flap Breast Reconstruction

Sign up for cpt 19364 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does CPT 19364 describe?

What preoperative and intraoperative steps are included in the clinical context for this procedure?

What postoperative care and monitoring are described for patients undergoing this free flap reconstruction?

Is CPT 15734 reportable with CPT 19364?

What diagnoses are listed as clinically relevant for reporting CPT 19364?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does CPT 19364 describe?

What preoperative and intraoperative steps are included in the clinical context for this procedure?

What postoperative care and monitoring are described for patients undergoing this free flap reconstruction?

Is CPT 15734 reportable with CPT 19364?

What diagnoses are listed as clinically relevant for reporting CPT 19364?

References