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See a sample rate comparisonCPT 19364 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 Reconstruction, Surgery To Reconstruct A Breast Or Nipple After A Mastectomy. The Procedure May Use Tissue Expanders Implants Skin Or Muscle Flaps Or Other Reconstructive Devices. Additional Procedures May Be Needed To Achieve The Desired Size Or Shape.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 50 - Bilateral Procedure None 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 19364 |
| Medicaid Fee Schedule | View Medicaid rates for 19364 |
National average reimbursement for CPT 19364 by major payers:
$4,384.15
$3,617.49
$4,139.37
$4,472.30
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CPT 19364
5 of 25 sample ratesHigher to lower in this preview
Surgical Caregivers Of Fort Worth LLC, Texas Health Surgery Center Fort Worth Midtown
Surgical Caregivers Of Fort Worth LLC
$8,238.00Published rateSpine Care Delaware, LLC
Spine Care Delaware LLC
$3,968.00Published ratePsg Surgery Center LLC, Surgery Center Of Amarillo
Psg Surgery Center LLC
$2,800.00Published rateBel Air Endoscopy Asc LLC, Harford Endoscopy Center
Bel Air Endoscopy Asc LLC
$1,874.00Published ratePiedmont Endoscopy Center, Inc.
$518.00Published rate
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See a sample payer proposalCPT 19364 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19364 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 19364 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 |
|---|---|---|
| 19298-CPT | High | Place Breast Rad Tube Caths, Placement Of Radiotherapy After Loading Brachytherapy Catheters Multiple Tube And Button Type Into The Breast For Interstitial Radioelement Application Following At The Time Of Or Subsequent To Partial Mastectomy Includes Imaging Guidance |
| 19364-CPT | High | Breast Reconstruction, Surgery To Reconstruct A Breast Or Nipple After A Mastectomy. The Procedure May Use Tissue Expanders Implants Skin Or Muscle Flaps Or Other Reconstructive Devices. Additional Procedures May Be Needed To Achieve The Desired Size Or Shape. |
| 19367-CPT | High | Breast Reconstruction, Surgery To Reconstruct A Breast Or Nipple After A Mastectomy. The Procedure May Use Tissue Expanders Implants Skin Or Muscle Flaps Or Other Reconstructive Devices. Additional Procedures May Be Needed To Achieve The Desired Size Or Shape. |
| 19368-CPT | High | Breast Reconstruction, Surgery To Reconstruct A Breast Or Nipple After A Mastectomy. The Procedure May Use Tissue Expanders Implants Skin Or Muscle Flaps Or Other Reconstructive Devices. Additional Procedures May Be Needed To Achieve The Desired Size Or Shape. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19364. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19364 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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