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See a sample rate comparisonCPT 19318 Fee Schedule
Last Verified: October 2026
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, Surgery In Which Tissue Is Removed To Reduce The Size Of The Breasts (Reduction Mammaplasty).
| Key Fact | Detail |
|---|---|
| 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 Level | High |
| Medicare Fee Schedule | View Medicare rates for 19318 |
| Medicaid Fee Schedule | View Medicaid rates for 19318 |
National average reimbursement for CPT 19318 by major payers:
$1,397.16
$1,447.78
$1,559.56
$1,796.21
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CPT 19318
5 of 25 sample ratesHigher to lower in this preview
Christopher Noto
City Medical Of Upper East, PLLC
$5,601.10Published rateNikita Roy
North Shore-Lij Medical PC
$2,651.13Published rateDavid Meyer
Westchester Medical Center Advanced Physician Services, P.C
$2,204.40Published rateRobert Eagle
$1,976.86Published rateCity Medical Of Upper East Side, PLLC
City Medical Of Upper East, PLLC
$1,066.56Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 19316-CPT | High | Cosmetic Breast Lift, Cosmetic Surgery To Remove Excess Tissue And Shorten Muscles So That Breasts Move To A Higher Position On The Chest. |
| 19318-CPT | High | Breast Reduction, Surgery In Which Tissue Is Removed To Reduce The Size Of The Breasts (Reduction Mammaplasty). |
| 19325-CPT | Moderate | Cosmetic Enlargement Of Breast, Cosmetic Surgery To Enlarge The Size Of The Breasts. The Reconstruction May Be Done With Or Without An Implanted Prosthesis (Artificial Breast). |
| 19328-CPT | Moderate | Removal Of Breast Implant, Surgery To Remove A Prosthesis (Artificial Breast) Or Other Material Implanted In A Breast. |
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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