Summary & Overview
CPT 19370: Surgical Release of Breast Implant Capsule
CPT code 19370 represents the surgical release or removal of scar tissue (capsulotomy or capsulectomy) that forms around a breast implant. This procedure is performed to relieve pain, correct implant malposition, or address symptomatic capsular contracture, and it is a distinct surgical service within breast reconstruction and implant management. Nationally, accurate use of this code matters for clinical documentation, surgical quality reporting, and payment clarity across commercial and public payers.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and payer coverage considerations. The publication highlights common billing modifiers associated with surgical services and describes the typical surgical setting for 19370.
This piece provides operational benchmarks and policy-relevant information useful for coding and billing teams, revenue cycle managers, and surgical practices. It outlines what to expect in payer interactions, summarizes clinical reasons the procedure is performed, and identifies where to look for additional coding guidance. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 19370 describes the surgical release of a breast capsule or scar tissue that has formed around a prior breast implant. The procedure addresses symptomatic capsular contracture or implant malposition by excising or releasing constricting scar tissue within the breast.
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Service type: Surgical procedure — implant capsule release (capsulotomy/capsulectomy)
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Typical site of service: Hospital outpatient department or ambulatory surgical center; may also be performed in a physician-owned surgical facility depending on clinical setting and patient needs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with prior bilateral breast augmentation presents with progressive right breast firmness, pain, and distortion of contour over several months. Examination demonstrates capsular contracture Grade III with implant malposition. Imaging (diagnostic mammography and ultrasound) excludes implant rupture and malignancy. The surgeon schedules operative capsulotomy/capsulectomy with possible implant exchange under general anesthesia in an outpatient ambulatory surgery center. Preoperative steps include history/physical, informed consent, and verification of implant details. Intraoperatively, the provider performs a surgical release of the periprosthetic capsule around the implant to relieve contracture and to reposition or exchange the implant. Hemostasis is obtained, implants are irrigated, and drains may be placed if indicated. The patient is observed in PACU and discharged home with routine postoperative wound care and follow-up for drain removal and healing assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional component for a diagnostic service provided separately from the facility/technical component (rare for this surgical CPT). |
50 | Bilateral procedure | Use when the capsulotomy/capsulectomy is performed on both breasts during the same operative session. |
51 | Multiple procedures | Use when additional unrelated procedures are performed in the same operative session and payer requires modifier for multiple procedures. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but aborted due to patient safety concerns. |
59 | Distinct procedural service | Use when a separate, distinct procedural service not normally reported together is performed (e.g., simultaneous unrelated breast procedure). |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the procedure. |
76 | Repeat procedure by same physician | Use when the same physician performs the procedure again during the postoperative period. |
79 | Unrelated procedure or service by same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
22 | Increased procedural services | Use when the work required to perform the capsulotomy/capsulectomy is substantially greater than typical and documentation supports additional reimbursement. |
23 | Unusual anesthesia | Use when general anesthesia is not appropriate and the procedure is performed under local/regional anesthesia in unusual circumstances. |
52 | Reduced services | Use when less than the full procedure is performed (duplicate of above entry to emphasize applicability). |
VZ | Data not available in the input. | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Plastic Surgery | Primary specialty performing implant-related capsule surgery. |
| 206E00000X | General Surgery | General surgeons with breast focus may perform capsulectomy in reconstructive cases. |
| 207P00000X | Otolaryngology? | Data not available in the input. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
T85.49 | Other mechanical complication of breast implant and graft | Common code for implant-related complications including capsular contracture when specific codes are used for mechanical issues. |
M24.41 | Contracture of joint — Data not available in the input. | Data not available in the input. |
N64.89 | Other specified disorders of breast | Used for nonspecific breast symptoms like pain or firmness related to capsular contracture. |
T85.39 | Displacement of breast implant | Relevant when implant malposition accompanies capsular contracture requiring surgical correction. |
Z98.890 | Other specified postprocedural states | May be used for postoperative history of breast implant status in the medical record. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19325 | Breast augmentation with implant | Performed when primary augmentation or implant exchange is part of the operative plan; implant insertion may follow capsulectomy. |
19328 | Removal of intact breast implant | Used when the implant is removed (explantation) during capsulectomy without immediate replacement. |
19330 | Radical mastectomy | Data not available in the input. |
19000 | Puncture aspiration of breast cyst | Performed preoperatively for diagnostic or therapeutic reasons in breast pathology evaluation. |
76942 | Ultrasonic guidance for needle placement | May be used preoperatively for imaging-guided diagnostic procedures related to implant evaluation. |