Summary & Overview
CPT 19371: Breast Implant Capsule Release with Intracapsular Removal
CPT code 19371 represents a surgical procedure to release a capsule or scar tissue that forms around a breast implant and to remove intracapsular contents such as fibrous scar and associated tissues. This code captures a targeted corrective operation for complications of breast implants, including symptomatic capsular contracture, and is relevant to hospitals, ambulatory surgical centers, plastic surgeons, and payers managing post-implant complications. Nationally, payers evaluate this code for medical necessity, site-of-service appropriateness, and bundling against related breast surgery codes.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement patterns, discussion of common billing and coverage considerations, and clinical context explaining when the procedure is typically indicated. The publication outlines coding nuances, documentation elements frequently reviewed by payers, and potential policy updates that affect preauthorization and site-of-service determinations. This summary equips billing managers, surgical practices, and policy analysts with an overview of how CPT code 19371 is used and reviewed across major payers and care settings.
Billing Code Overview
CPT code 19371 describes a surgical procedure to release a capsule or scar tissue that forms within the breast tissue around a prior implant and to remove all intracapsular contents, including tissues and fibrous scar. This procedure addresses complications related to breast implants such as capsular contracture and intracapsular fibrotic tissue.
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Service type: Surgical, breast implant capsule release with intracapsular removal
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Typical site of service: Hospital outpatient department or ambulatory surgical center; inpatient settings may be used when clinically indicated
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a history of cosmetic breast augmentation presents with progressive breast firmness, pain, and visible distortion of the implant contour over several months. Clinical exam and breast ultrasound confirm a contracted peri-implant capsule consistent with capsular contracture. The surgical plan is an open capsulectomy with removal of intracapsular fibrous tissue and any nonviable tissue surrounding the implant. The procedure is performed in an outpatient ambulatory surgery center under general anesthesia.
Preoperative workflow includes history and physical, informed consent discussing risks (bleeding, infection, implant damage, need for implant exchange or removal), imaging as indicated, and marking for incision and implant pocket. Intraoperative steps include incision, exposure of the implant capsule, careful capsulectomy or capsulotomy, removal of intracapsular scar and debris, assessment of the implant integrity, and decision on immediate implant replacement versus explantation. Postoperative workflow includes PACU recovery, discharge instructions, short-term antibiotic and analgesic management, and scheduled follow-up for wound check and assessment of cosmetic outcome.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when a bilateral capsulectomy is performed and the payer requires the bilateral modifier rather than separate lines. |