2025 CPT code 19318
(Active) Effective Date: N/A Surgery - Integumentary System Surgery Feed
Reduction mammaplasty.
Modifiers can be applied to 19318 to indicate specific circumstances, such as bilateral procedures (-50), increased procedural services (-22), or reduced services (-52).
Medical necessity for breast reduction is established by demonstrating functional impairment and/or significant symptoms related to macromastia, such as back pain, shoulder grooving, intermammary rash, and postural problems. Documentation should clearly link the procedure to the relief of these symptoms.
The surgeon makes incisions, removes excess skin, tissue, and fat, reshapes the breast, and repositions the nipple.Drains may be placed, and the incisions are closed.
In simple words: Breast reduction surgery makes breasts smaller by removing extra fat, tissue, and skin. This creates a breast size that is more in proportion with the body and can relieve discomfort caused by large breasts.
Reduction mammaplasty is a surgical procedure performed to remove excess breast tissue, fat, and skin. This procedure reshapes and elevates the breasts to create a smaller, more proportionate bust size. It addresses issues related to macromastia, including back pain, shoulder grooving, and intermammary rash.
Example 1: A patient experiences significant back and shoulder pain due to excessively large breasts. Breast reduction surgery (19318) is performed to alleviate these symptoms and improve the patient's quality of life., A patient with macromastia presents with deep grooves in their shoulders from bra straps and a persistent intermammary rash. The surgeon performs a reduction mammaplasty (19318) to address these issues and reshape the breasts., A patient with gigantomastia during pregnancy experiences significant discomfort and postural issues.After delivery, they undergo breast reduction surgery (19318) to achieve a more manageable and comfortable breast size.
Documentation should include the patient's medical history, physical exam findings (including breast size and associated symptoms), pre-operative photographs, operative report detailing the techniques used and tissues removed, and post-operative care instructions.
- Revenue Code: P1A (MAJOR PROCEDURE - BREAST)
- Payment Status: Active
- Specialties:Plastic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital, Office