2025 CPT code 19364
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Integumentary System - Breast Reconstruction Surgery Feed
Breast reconstruction using a free flap (e.g., fTRAM, DIEP, SIEA, GAP flap).
Modifiers 22 (Increased Procedural Services), 50 (Bilateral Procedure), and 51 (Multiple Procedures) may be applicable depending on the circumstances of the procedure.
Medical necessity for breast reconstruction with a free flap is established in cases of breast cancer-related mastectomies, congenital breast deformities, or traumatic breast injuries where reconstruction improves the patient's physical and psychological well-being. Documentation of the deformity and medical necessity should be clearly present in patient records.
The surgeon is responsible for all aspects of the procedure, including flap harvest, microsurgical anastomosis, flap inset, and donor site closure. Pre-operative and post-operative care is also the responsibility of the surgeon and their team. Anesthesia services are billed separately.
In simple words: The surgeon creates a new breast using tissue from another part of your body. This tissue is completely separated from its original blood supply and reattached to blood vessels in your chest. This is a complex operation requiring microsurgery.
This CPT code encompasses breast reconstruction utilizing a microsurgical free tissue transfer of skin, subcutaneous fat, and/or muscle.The procedure involves harvesting the flap from a donor site (e.g., abdomen, buttocks, thigh), performing microsurgical anastomosis of at least one artery and two veins using an operating microscope, insetting the flap to create a breast mound, and closing the donor site.Examples of free flaps include free transverse rectus abdominis myocutaneous (fTRAM), deep inferior epigastric perforator (DIEP), superficial inferior epigastric artery (SIEA), or gluteal artery perforator (GAP) flaps.
Example 1: A 45-year-old female undergoes a mastectomy for breast cancer. Following the mastectomy, she opts for immediate breast reconstruction using a DIEP flap. The surgeon harvests the flap from her lower abdomen, performs microsurgical anastomosis, and creates a new breast mound., A 50-year-old female patient presents with a large, congenital breast deformity.She undergoes breast reconstruction with a GAP flap to increase breast volume and improve symmetry., A 38-year-old female patient has undergone a previous mastectomy with unsatisfactory results. She undergoes revision breast reconstruction using a fTRAM flap combined with implant placement to correct contour irregularities and improve symmetry.
* Detailed operative report describing the flap type, donor site, recipient site, and microsurgical anastomosis.* Photographs of the pre-operative and post-operative results.* Pathology reports (if applicable).* Consent form.* Medical history and physical examination notes.* Anesthesia records.
** This code is for complex microsurgical procedures.Accurate coding requires precise documentation of the specific free flap utilized and any additional procedures performed during the same operative session.
- Revenue Code: P1A (Major Procedure - Breast)
- RVU: This information is not available in the provided text and varies depending on geographic location and payer.
- Global Days: The global period for this procedure is dependent on payer guidelines and may vary.Consult the payer's specific fee schedule.
- Payment Status: Active
- Modifier TC rule: This code does not typically utilize a technical component (TC) modifier.
- Fee Schedule: Historical fee schedule data is not available in the provided text and varies based on location, payer, and year.
- Specialties:Plastic Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center