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CPT 19318 Fee Schedule

Last Verified: December 2025

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Breast Reduction (Desc Rvsd 1/1/21)
Key FactDetail
Service Type

Surgery

Surgical Procedures on the Integumentary System

Common Place of Service

22 - On Campus Outpatient Hospital

24 - Ambulatory Surgical Center

Common Modifiers

None

50 - Bilateral Procedure

LT - Left side of body

Complexity LevelHigh

National average reimbursement for CPT 19318 by major payers:

bcbs

$1,397.16

uhc

$1,447.78

aetna

$1,559.56

cigna

$1,839.50

Preview provider-level rates for...
For billing codeCPT 19318
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 19318

United
19318$1704.711144305913 - DAVID GREENWALD611661781NYGastroenterology Physician (207RG0100X)
United
19318$2566.871962494591 - JOSE LEON453023019 - NORTH SHORE-LIJ MEDICAL PCNYInternal Medicine Physician (207R00000X)
United
19318$2651.131801356415 - KENNY TANG453023019 - NORTH SHORE-LIJ MEDICAL PCNYHospitalist Physician (208M00000X)
United
19318$2322.841841900883 - SOPHIA RAFFAI611661781NYPhysician Assistant (363A00000X)
United
19318$5271.601538449467 - JODI BROWN453023019 - NORTH SHORE-LIJ MEDICAL PCNYPhysician Assistant (363A00000X)
United
19318$1574.221366407546 - PAL LEKAJ264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.CNYFamily Medicine Physician (207Q00000X)
United
19318$1665.791164781019 - HARPAUL BHAMRA135562308 - NEW YORK UNIVERSITYNYCritical Care Medicine (Internal Medicine) Physician (207RC0200X)
United
19318$2566.871659354991 - HARRY FISCHER453023019 - NORTH SHORE-LIJ MEDICAL PCNYRheumatology Physician (207RR0500X)
United
19318$5190.091487898276 - PREETI SUBHEDAR133544120 - CAREMOUNT MEDICAL, P.C.GASurgical Oncology Physician (2086X0206X)
United
19318$2651.131073791117 - DOLLY SHARMA453023019 - NORTH SHORE-LIJ MEDICAL PCNYPediatric Infectious Diseases Physician (2080P0208X)
United
19318$1405.251194194167 - JESSICA DEMAIO135562308 - NEW YORK UNIVERSITYNYPhysician Assistant (363A00000X)
United
19318$2651.131568409803 - IRA WEG453023019 - NORTH SHORE-LIJ MEDICAL PCNYCardiovascular Disease Physician (207RC0000X)
United
19318$2120.901699338780 - KHURRAM KHALID453023019 - NORTH SHORE-LIJ MEDICAL PCNYInternal Medicine Physician (207R00000X)
United
19318$2823.031710907415 - JOSE FONTANEZ133544120 - CAREMOUNT MEDICAL, P.C.NYInternal Medicine Physician (207R00000X)
United
19318$879.861710383542 - VALERIE SCARAFIA135562308 - NEW YORK UNIVERSITYFLGerontology Nurse Practitioner (363LG0600X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 19318 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 19318 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 19318 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
19316-CPTHighMastopexy
19318-CPTHighBreast Reduction (Desc Rvsd 1/1/21)
19325-CPTModerateBreast Augmentation With Implant (Desc Rvsd 1/1/21)
19328-CPTModerateRemoval Of Intact Breast Implant (Desc Rvsd 1/1/21)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19318. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 19318 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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