Summary & Overview
CPT 19380: Breast Revision for Cosmetic or Complication Correction
CPT code 19380 represents surgical breast revision performed to improve an unacceptable cosmetic appearance or to address complications after prior breast surgery. As a targeted corrective procedure, it is used across cosmetic and reconstructive practices and has implications for coverage determinations, medical necessity review, and surgical planning. Nationally, this code matters because it intersects aesthetic and reconstructive care pathways and prompts payer review of clinical indications for revision.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and authorization considerations used by major commercial insurers and Medicare, common clinical contexts prompting revision, and typical sites where the service is delivered. The publication summarizes benchmarks for utilization and payment classification context, highlights policy elements that influence prior authorization and documentation, and explains clinical scenarios that commonly support medical necessity for revision procedures.
The content provides clinicians, billing staff, and policy analysts with a concise reference to understand what CPT code 19380 captures, how payers typically approach coverage decisions, and what clinical documentation and procedural context are relevant for claims processing and authorization reviews.
Billing Code Overview
CPT code 19380 describes a breast revision procedure performed to improve an unacceptable cosmetic appearance or to address another complication following a prior breast surgery. The service type is surgical revision of the breast, typically involving correction of contour, symmetry, implant-related issues, scar revision, or other postoperative aesthetic or reconstructive concerns. The typical site of service is an ambulatory surgery center or hospital outpatient surgical setting, with some procedures performed in an office-based surgical suite depending on complexity and local practice patterns.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old woman with prior breast augmentation who presents with persistent implant malposition and dissatisfaction with cosmetic appearance, reporting asymmetry, capsular contracture, and peri-implant pain. Evaluation includes history, focused breast exam, and preoperative imaging as needed (mammography and ultrasound). The surgeon documents the unacceptable cosmetic result and discusses options: capsulectomy, implant exchange, pocket revision, mastopexy, scar revision, or removal. Consent and preoperative clearance are completed. On the day of service the procedure is performed in an ambulatory surgical center or hospital outpatient setting under general anesthesia. Postoperative workflow includes immediate recovery, wound care instructions, follow-up visits at 1–2 weeks and 6 weeks, and documentation of aesthetic outcome and any complications. Billing uses 19380 for breast revision procedures aimed at improving unacceptable cosmetic appearance or addressing complications such as capsular contracture, malposition, or implant rupture.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time substantially exceeds usual for 19380 due to extensive revision, concurrent procedures, or difficult anatomy |
59 | Distinct procedural service | Use when a separate, distinct procedure not normally billed together is performed during the same operative session |
76 | Repeat procedure by same physician | Use when the same procedure 19380 is repeated later during the global period by the same provider |
77 | Repeat procedure by another physician | Use when another physician repeats the procedure within the global period |
78 | Return to the operating room for a related procedure during the global period | Use for unplanned reoperation related to the initial 19380 during the global period |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated surgical procedure is performed during the global period |
50 | Bilateral procedure | Use when revision is performed on both breasts and payer requires bilateral reporting |
52 | Reduced services | Use when a planned revision is partially performed or aborted and reduced services are provided |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances |
25 | Significant, separately identifiable E/M on same day | Use when a qualifying preoperative or postoperative E/M visit is performed on the same day as 19380 |
26 | Professional component | Use if reporting only the physician’s professional component where payer separates technical services |
TC | Technical component | Use if reporting only the technical component when payer separates professional and technical components |
58 | Staged or related procedure or service by same physician during the global period | Use when 19380 is planned as part of a staged reconstruction or aesthetic plan |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| Data not available in the input. | Plastic Surgery | Most common specialty performing breast revision procedures |
| Data not available in the input. | General Surgery (Breast) | Surgeons focusing on breast procedures may perform revisions |
| Data not available in the input. | Otolaryngology - Head & Neck Surgery | Occasionally performs cosmetic breast work in multidisciplinary practices |
| Data not available in the input. | Surgical Oncology (Breast) | May perform revisions when related to oncologic reconstruction |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N64.89 | Other specified disorders of breast | Used for various breast complications prompting revision such as chronic pain or contour deformity |
T85.49XA | Mechanical complication of other internal prosthetic device, implant and graft, initial encounter | Used for implant malposition, rupture, or mechanical failure leading to revision |
T85.44XA | Infection and inflammatory reaction due to internal prosthetic device, implant and graft, initial encounter | Indicates implant-related infection that may necessitate revision or removal |
N64.4 | Mastodynia | Breast pain associated with implants that may contribute to decision for revision when persistent |
T85.42XA | Hematoma due to internal prosthetic device, initial encounter | Postoperative hematoma around implant that may require revision |
T81.4XXA | Infection following a procedure, initial encounter | General code for postoperative infection related to prior breast surgery leading to revision |
M79.1 | Myalgia | Pain symptoms that can be associated with implant-related complications prompting revision |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19325 | Augmentation mammoplasty, including prosthetic implantation | Often the index procedure preceding revision when implants are in place |
19340 | Mastectomy, simple, complete | May precede or be related when revision follows oncologic surgery or reconstruction |
19342 | Immediate insertion of breast implant following mastopexy, mastectomy or in reconstruction | Performed when revision includes implant exchange or immediate reconstruction |
19350 | Nipple/areola reconstruction | Performed after revision to address aesthetic and reconstructive goals |
11970 | Application of skin substitute graft to wound | Occasionally performed adjunctively when complex soft-tissue defects are present |
20680 | Removal of implant; foreign body from soft tissue | Used when implant removal is performed as part of the revision |