2025 CPT code 19350
Effective Date: N/A Surgery - Integumentary System Feed
Nipple/areola reconstruction.
Modifiers may be applicable. Modifier 50 is used for bilateral procedures.
Medical necessity for nipple/areola reconstruction is established when performed as part of breast reconstruction following mastectomy, lumpectomy, or other breast surgery to restore normal anatomy and improve the patient's body image and quality of life. Documentation should support the functional and psychological impact of the breast defect.
The physician performs nipple/areola reconstruction using various surgical techniques like nipple sharing, skate flap, C-V flap, or local flaps. In nipple sharing, the physician harvests a composite graft from the opposite nipple, de-epithelializes the vascular bed at the recipient site, transfers the graft, and reconstructs the areola.
In simple words: Reconstruction of the nipple and areola (the darker skin around the nipple) using various surgical techniques.
Nipple/areola reconstruction. This includes techniques such as nipple sharing, skate flap, C-V flap, or a local flap. Nipple sharing involves harvesting a composite graft from the opposite nipple, transferring it to the recipient site, and reconstructing the areola with tattooing or a full-thickness technique. Layered closure is performed at both donor and recipient sites.
Example 1: A patient post-mastectomy desires nipple reconstruction using a local flap technique., A patient undergoes nipple reconstruction using the C-V flap technique after breast conservation surgery., A patient post-lumpectomy and radiation therapy requires nipple reconstruction using nipple sharing.
Operative report detailing the nipple/areola reconstruction technique (e.g., nipple sharing, skate flap, local flap), size and location of the defect, closure method, and any complications. Pre- and postoperative photographs are recommended. If nipple sharing is performed, document the harvest and recipient site details.
** As of December 1st, 2024, this information is current. However, medical coding and billing regulations are subject to change, and it is crucial to stay updated on the latest guidelines.
- Revenue Code: P1A - MAJOR PROCEDURE - BREAST
- Specialties:Plastic Surgery, Reconstructive Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office