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See a sample rate comparisonCPT 19370 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 50 - Bilateral Procedure RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19370 |
| Medicaid Fee Schedule | View Medicaid rates for 19370 |
National average reimbursement for CPT 19370 by major payers:
$889.40
$882.42
$913.45
$1,097.15
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CPT 19370
5 of 25 sample ratesHigher to lower in this preview
Orthopedic Surgery Center Of Oc LLC
$4,498.00Published rateWestminster Surgery Center
Westminster Surgery Center LLC
$3,347.00Published rateLone Tree Surgery Center, LLC
Lone Tree Surgery Center LLC
$2,186.00Published rateMinimally Invasive Surgical And Neuroscience LLC, Delaware Outpatient Center For Surgery
Delaware Outpatient Center For Surgery
$1,819.00Published rateBergen Gastroenterology PC
Bergen Gastroenterology, P.C.
$705.00Published rate
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See a sample payer proposalCPT 19370 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19370 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 19370 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 |
|---|---|---|
| 19369-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. |
| 19370-CPT | Moderate | 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. |
| 19371-CPT | Moderate | 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. |
| 19380-CPT | High | Revision Of Reconstructed Breast (Eg Significant Removal Of Tissue Re-Advancement And/Or Re-Inset Of Flaps In Autologous Reconstruction Or Significant Capsular Revision Combined With Soft Tissue Excision In Implant-Based Reconstruction) (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 19370. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19370 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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