2025 CPT code 19316
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Integumentary System Surgery Feed
Mastopexy, or breast lift, a surgical procedure to lift and reshape breasts.
Modifiers such as 50 (bilateral procedure), 22 (increased procedural services), or others may be appropriate depending on the circumstances.
Medical necessity for mastopexy is typically based on the patient's desire to improve breast appearance and symmetry.However, in some cases, significant breast ptosis may cause physical discomfort or interfere with activities of daily living.Documentation should support the medical necessity.
The clinical responsibility involves the surgeon performing the mastopexy, selecting appropriate incision patterns and techniques based on patient anatomy, and ensuring proper closure of incisions.Preoperative and postoperative care, including anesthesia, is also part of the clinical responsibility, although potentially billed separately.
In simple words: A breast lift, or mastopexy, is a surgery to lift and improve the shape of breasts. The surgeon removes excess skin and tightens the breast tissue to give the breasts a higher, firmer look.
Mastopexy, also known as a breast lift, is a surgical procedure to reposition and reshape the breasts.The procedure involves removing excess skin and tightening underlying breast tissue to achieve a more aesthetically pleasing position. Various incision patterns and techniques may be used depending on individual patient factors such as breast size, shape, areola position, and skin quality.These techniques may involve steps such as thinning, lifting, and reshaping tissues; repositioning the nipple and areola; and placing deep stitches. Incisions are then closed, further tightening the skin.
Example 1: A 45-year-old female patient presents with ptosis (sagging) of the breasts following significant weight loss.Mastopexy is performed to lift and reshape the breasts, improving their appearance and restoring symmetry., A 38-year-old patient desires breast lift to improve the shape and appearance of her breasts after breastfeeding. A mastopexy with a vertical incision technique is chosen to address significant ptosis., A 50-year-old patient undergoes a bilateral mastopexy as part of a comprehensive breast rejuvenation procedure. This might be reported with modifier 50 to indicate bilateral procedure.
Preoperative photographs, operative report detailing the technique used (e.g., vertical, periareolar, etc.), postoperative photographs, and any relevant patient history (e.g., previous surgeries, medical conditions) are required.
** Payers may have specific coverage policies for mastopexy. It's crucial to verify coverage and medical necessity requirements before performing and billing for the procedure. The CPT code description does not include specific details of the various techniques.Therefore, accurate documentation in the operative report is essential for correct coding and reimbursement.
- Revenue Code: P1A (Major Procedure - Breast)
- RVU: This information is not available in provided sources. Consult the AMA CPT codebook or a relevant payer's fee schedule for current RVU values.
- Payment Status: Active
- Modifier TC rule: The information provided does not specify the applicability of a Technical Component (TC) modifier.Consult the appropriate guidelines.
- Fee Schedule : This information is not available in provided sources.Consult the AMA CPT codebook or a relevant payer's fee schedule for historical fee data.
- Specialties:Plastic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital