2025 CPT code 19361
(Active) Effective Date: N/A Revision Date: N/A Surgery - Integumentary System Feed
Breast reconstruction using a latissimus dorsi flap.
Modifiers are applicable. Modifier 50 for bilateral procedures, modifier LT or RT for laterality.
Medical necessity is established by the diagnosis necessitating breast reconstruction, such as a history of mastectomy or congenital anomaly. Documentation should clearly justify reconstruction rather than alternative options.
The surgeon performs the procedure, including incision, flap elevation, transfer, and closure of both the recipient and donor sites.
In simple words: This procedure reconstructs the breast using tissue and muscle from your back, creating a new breast shape after a mastectomy or to repair a defect. It doesn't involve using a breast implant.
Breast reconstruction with latissimus dorsi flap, without prosthetic implant. This involves harvesting a flap of skin, subcutaneous fat, and muscle from the back, preserving its blood supply, and transferring it to the chest to create a breast mound.It does not include placement of a prosthetic implant.
Example 1: A patient undergoes delayed breast reconstruction following a mastectomy using a latissimus dorsi flap without an implant., A patient with a congenital breast defect undergoes reconstruction using a latissimus dorsi flap., A patient chooses autologous breast reconstruction with a latissimus dorsi flap after a lumpectomy.
Documentation should include the type of mastectomy or defect, the method of reconstruction, operative details, and the size and location of the flap.
** This code describes the reconstruction of the breast mound without an implant. Any additional procedures like nipple reconstruction (19350), capsular contracture treatment (19370, 19371), or revisions (19380) would be reported separately.The placement of a tissue expander (19357) or breast implant (19340,19342) at the time of reconstruction would also be separately reportable.
- Revenue Code: P1A
- Global Days: 90 days
- Payment Status: Active
- Modifier TC rule: No, the TC modifier does not apply to this code.
- Fee Schedule: Fee schedules vary based on location and payer. Consult historical CMS fee schedules or other resources.
- Specialties:Plastic Surgery, Reconstructive Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center