CPT 19316
Global 090 ActiveMastopexy
CPT 19316 Billing & Documentation Guide
CPT code 19316 (Mastopexy) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 10.81, a non-facility practice expense RVU of 8.89, and a malpractice RVU of 2.13, a total non-facility RVU of 21.83 and facility RVU of 21.83. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $739.23, though rates vary from $652.77 to $897.03 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19316, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 19316 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 19316 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 19316
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.81 | 10.81 |
| Practice Expense RVU | 8.89 | 8.89 |
| Malpractice RVU | 2.13 | 2.13 |
| Total RVU | 21.83 | 21.83 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19316
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $763.94 | $763.94 | $730.77 - $867.09 | 29 |
| Florida | $797.48 | $797.48 | $751.86 - $850.09 | 3 |
| Georgia | $730.01 | $730.01 | $710.73 - $749.28 | 2 |
| Illinois | $785.2 | $785.2 | $743.36 - $825.29 | 4 |
| Michigan | $740.02 | $740.02 | $712.49 - $767.55 | 2 |
| North Carolina | $683.56 | $683.56 | $683.56 - $683.56 | 1 |
| New York | $806.17 | $806.17 | $693.17 - $869.34 | 5 |
| Ohio | $703.88 | $703.88 | $703.88 - $703.88 | 1 |
| Pennsylvania | $731.21 | $731.21 | $700.88 - $761.55 | 2 |
| Texas | $721.47 | $721.47 | $697.37 - $756.7 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 19316
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19316 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00400 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 19316
What does CPT code 19316 mean? +
CPT code 19316 represents: Mastopexy. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19316? +
The 2026 Medicare national average non-facility payment for CPT 19316 is $739.23. Rates range from $652.77 to $897.03 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19316? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 19316? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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