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    OpenPayerBilling CodesRepair and/or Reconstruction Procedures on the BreastCPT cpt-19367-pedicled-tram-flap-breast-reconstruction
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    CPT 19367: Pedicled TRAM Flap Breast Reconstruction

    Medicare pays $1584 on average nationally for this procedure.

    CPT code 19367 describes a pedicled TRAM flap breast reconstruction in which a flap of skin, fat, and transverse rectus abdominis muscle is harvested from the lower abdomen and tunneled on a vascularized pedicle to recreate the breast contour after mastectomy; service type: autologous tissue breast reconstruction, typical site of service: inpatient or outpatient surgical setting (operating room) for reconstructive breast surgery.

    For related coverage guidance, see recent payer policy updates: Removal of Implantable Devices, Removal of Implantable Devices, Removal of Implantable.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a woman following mastectomy for breast cancer who presents for staged autologous reconstruction using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap (19367). The patient is evaluated preoperatively in a multidisciplinary clinic including the breast surgeon, plastic surgeon, medical oncology and radiation oncology as applicable. Preoperative workup includes medical optimization, review of prior oncologic treatments (chemotherapy, radiation), vascular and abdominal wall assessment, imaging as needed, and consent for potential bilateral reconstruction or symmetry procedures.

    Intraoperative workflow involves general anesthesia, prophylactic antibiotics, marking of the lower abdominal donor site, elevation of the pedicled TRAM flap with preservation of a vascularized pedicle, transfer of the flap to the chest and inset to recreate breast contour, possible placement of drains, and layered closure of donor and recipient sites. Postoperative care includes monitoring flap perfusion, pain control, deep venous thrombosis prophylaxis, wound and drain management, and coordination of follow-up for adjuvant therapy or revision procedures when indicated.

    A realistic scenario: a 52-year-old woman with left mastectomy six months prior, no active metastatic disease, cleared by oncology, elects delayed unilateral breast reconstruction with a pedicled TRAM flap (19367) to restore breast contour. Surgery is performed in an ambulatory surgical center or hospital operating room with an anticipated inpatient overnight stay for flap monitoring.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    19316Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansionAlternative reconstructive approach; may be performed before or instead of autologous TRAM reconstruction
    19318Breast reconstruction with latissimus dorsi flap, with or without implantAlternative autologous flap technique for breast reconstruction when TRAM is not indicated
    15734Muscle, myocutaneous or fasciocutaneous flap; trunkCodes for harvesting trunk-based flaps; may represent donor-site technique related to TRAM flap harvest
    15738Muscle, myocutaneous or fasciocutaneous flap; free flapUsed when reconstruction is performed as a free flap instead of a pedicled TRAM; different technique and vascular anastomosis
    11970Flap revision, minor; each additional procedureUsed for secondary revisions to contour or donor-site refinements following primary TRAM reconstruction
    49560Repair of initial incisional/ventral hernia, single layer; reducible

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207V00000X
    208200000X
    207P00000X
    364S00000X
    146L00000X
    208D00000X
    344600000X
    2084V0102X

    Related ICD-10-CM Codes

    20 rows

    ICD-10-CM CodeDescription
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.012Malignant neoplasm of nipple and areola, left female breast
    C50.121Malignant neoplasm of central portion of right male breast
    C50.219Malignant neoplasm of upper-inner quadrant of unspecified female breast
    C50.612Malignant neoplasm of axillary tail of left female breast
    C50.619Malignant neoplasm of axillary tail of unspecified female breast
    C50.911Malignant neoplasm of unspecified site of right female breast
    C50.912Malignant neoplasm of unspecified site of left female breast
    C50.922Malignant neoplasm of unspecified site of left male breast
    C50.929Malignant neoplasm of unspecified site of unspecified male breast

    Showing 1–10 of 20

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Removal of Implantable DevicesBlue Cross Blue Shield - Rhode Island2027-01-01
    Removal of Implantable DevicesBlue Cross Blue Shield - Rhode Island2027-01-01
    Removal of ImplantableBlue Cross Blue Shield - Rhode Island2026-10-01
    Cryosurgical Ablation of Primary or Metastatic Liver TumorsBluecross Idaho2026-09-24
    Percutaneous Laser Ablation of Benign and Malignant Breast Tumorsregence2026-09-01
    Plugs for Enteric and Anorectal Fistula Repairregence2026-09-01
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    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

    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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    Possible concurrent repair when donor site abdominal wall requires hernia repair at time of TRAM harvest