CPT 19350
Global 090 ActiveNipple/areola reconstruction
CPT 19350 Billing & Documentation Guide
CPT code 19350 (Nipple/areola reconstruction) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 8.88, a non-facility practice expense RVU of 16.21, and a malpractice RVU of 1.67, a total non-facility RVU of 26.76 and facility RVU of 18.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $915.46, though rates vary from $790.41 to $1139.86 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19350, 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 19350 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 19350 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 19350
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 8.88 | 8.88 |
| Practice Expense RVU | 16.21 | 7.89 |
| Malpractice RVU | 1.67 | 1.67 |
| Total RVU | 26.76 | 18.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19350
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 | $978.14 | $649.31 | $924.95 - $1139.86 | 29 |
| Florida | $948.42 | $669.59 | $898.04 - $1001.29 | 3 |
| Georgia | $880.31 | $615.19 | $846.04 - $914.57 | 2 |
| Illinois | $927.39 | $658.87 | $878.11 - $970.83 | 4 |
| Michigan | $883.51 | $622.57 | $853.9 - $913.12 | 2 |
| North Carolina | $837.4 | $578.12 | $837.4 - $837.4 | 1 |
| New York | $990.51 | $680.49 | $850.17 - $1062.92 | 5 |
| Ohio | $847.15 | $593.43 | $847.15 - $847.15 | 1 |
| Pennsylvania | $889.23 | $617.03 | $846.34 - $932.11 | 2 |
| Texas | $883.08 | $609.49 | $841.12 - $919.45 | 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 19350
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19350 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 19350
What does CPT code 19350 mean? +
CPT code 19350 represents: Nipple/areola reconstruction. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19350? +
The 2026 Medicare national average non-facility payment for CPT 19350 is $915.46. Rates range from $790.41 to $1139.86 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19350? +
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 19350? +
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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