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    OpenPayerBilling CodesRepair and/or Reconstruction Procedures on the BreastCPT cpt-19368-tram-flap-breast-reconstruction-microvascular
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    CPT 19368: TRAM Flap Breast Reconstruction with Microvascular Anastomosis

    Medicare pays $1914 on average nationally for this procedure.

    CPT code 19368 describes transfer of a lower abdominal myocutaneous flap including skin, fat, and transverse rectus abdominis muscle that is microvascularly anastomosed to recreate the breast contour after mastectomy; service type: autologous breast reconstruction using a pedicled/free TRAM flap with microvascular technique; typical site of service: operating room in an inpatient or outpatient surgical facility under general anesthesia for reconstructive breast surgery following mastectomy or to repair a postmastectomy defect.

    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 48-year-old woman with a history of left mastectomy for invasive ductal carcinoma presents for planned autologous breast reconstruction using a pedicled/transverse rectus abdominis myocutaneous (TRAM) flap with microvascular anastomosis to recreate breast contour. Preoperative workup includes oncologic clearance, imaging of the chest and abdomen, and assessment of abdominal vascular anatomy. The surgical team (plastic surgeon and anesthesiologist) evaluates comorbidities such as diabetes and smoking status and obtains informed consent addressing flap risks, donor-site morbidity, and possible need for revision. On the day of surgery the patient receives general anesthesia; the plastic surgeon harvests a lower abdominal flap containing skin, fat, and the transverse rectus abdominis muscle with its vascular pedicle, tunnels or transposes the flap to the mastectomy site, performs microvascular connection of flap vessels to recipient chest vessels, shapes the flap to restore breast contour, and closes donor and recipient sites. Postoperative care includes flap perfusion monitoring, pain control, DVT prophylaxis, wound care, and follow-up visits for assessment of healing and symmetry. Typical site of service is an inpatient hospital operating room or ambulatory surgical center with microsurgical capabilities and an overnight stay for flap monitoring when inpatient care is required. Common clinical indications include reconstruction after mastectomy, repair of post-oncologic defects, or revision of prior reconstructive failure.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    19318Reduction mammoplastyMay be performed simultaneously for symmetry or contralateral balancing during reconstruction.
    19350Nipple/areola reconstructionCommon secondary procedure performed after the initial flap reconstruction to restore nipple-areolar complex.
    15734Muscle, myocutaneous, or fasciocutaneous flap (trunk)Descriptor for flap harvest techniques; may be used for portions of donor-site reporting depending on payer bundling.
    97607Negative pressure wound therapy (wound VAC)May be used postoperatively for donor-site or chest wound management when indicated.
    36415Collection of venous blood by venipunctureRoutine perioperative labs; often performed pre- and postoperatively for monitoring.
    20926Muscle or myocutaneous free flap with microvascular anastomosis (muscle or myocutaneous)Alternate coding for free flap reconstruction in some payer contexts and for related muscle-based free flap procedures.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    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…
    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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    207P00000X
    2080P0206X
    2084P0800X
    363L00000X
    1835I0206X
    207RA0002X
    207RA0001X

    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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