CPT 19342
Global 090 ActiveInsj/rplcmt brst implt sep d
CPT 19342 Billing & Documentation Guide
CPT code 19342 (Insj/rplcmt brst implt sep d) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 10.22, a non-facility practice expense RVU of 8.66, and a malpractice RVU of 1.91, a total non-facility RVU of 20.79 and facility RVU of 20.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $704.81, though rates vary from $622.68 to $855.24 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19342, 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 19342 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 19342 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 19342
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.22 | 10.22 |
| Practice Expense RVU | 8.66 | 8.66 |
| Malpractice RVU | 1.91 | 1.91 |
| Total RVU | 20.79 | 20.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19342
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 | $730.45 | $730.45 | $698.37 - $830.2 | 29 |
| Florida | $755.76 | $755.76 | $713.77 - $803.81 | 3 |
| Georgia | $694.15 | $694.15 | $675.41 - $712.88 | 2 |
| Illinois | $743.96 | $743.96 | $705.16 - $780.86 | 4 |
| Michigan | $702.76 | $702.76 | $677.47 - $728.04 | 2 |
| North Carolina | $651.99 | $651.99 | $651.99 - $651.99 | 1 |
| New York | $766.96 | $766.96 | $660.99 - $825.59 | 5 |
| Ohio | $669.75 | $669.75 | $669.75 - $669.75 | 1 |
| Pennsylvania | $695.95 | $695.95 | $667.18 - $724.72 | 2 |
| Texas | $687.26 | $687.26 | $663.84 - $719.1 | 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 19342
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19342 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 19342
What does CPT code 19342 mean? +
CPT code 19342 represents: Insj/rplcmt brst implt sep d. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19342? +
The 2026 Medicare national average non-facility payment for CPT 19342 is $704.81. Rates range from $622.68 to $855.24 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19342? +
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 19342? +
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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