2025 CPT code 19367
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Integumentary System - Integumentary System Surgery Feed
Breast reconstruction with a single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap.
Yes, modifiers are applicable.
Medical necessity must be established for breast reconstruction, whether for post-mastectomy repair, correction of congenital defects, or other medical conditions. Documentation must support the patient's condition and the rationale for choosing this specific procedure. Payer-specific guidelines should be consulted.
The surgeon is responsible for all aspects of the procedure, including patient selection, preoperative planning, flap harvest, microsurgical transfer, shaping of the breast mound, donor site closure, and postoperative care.
In simple words: The surgeon reconstructs the breast using tissue from the patient's lower abdomen. This tissue, including skin, fat, and muscle, is moved to the chest area to create a new breast shape while remaining connected to its original blood supply. The abdominal area where the tissue was taken from is then closed.
This procedure involves using tissue from the patient's lower abdomen, including skin, fat, and a portion of the rectus abdominis muscle, to reconstruct the breast. The flap remains attached to its original blood supply (single pedicle) during transfer. The procedure includes flap harvesting, donor site closure, and shaping/placement of the flap to form the breast mound.A tissue expander or breast implant may be placed beneath the TRAM flap for additional volume (reported separately).
Example 1: A patient undergoes delayed breast reconstruction following a mastectomy using a single-pedicled TRAM flap., A patient with a congenital breast defect undergoes reconstruction using a single-pedicled TRAM flap and a tissue expander. , A patient undergoes bilateral breast reconstruction, with a single-pedicled TRAM flap on one side and a free flap on the other side.
Documentation should include details of the mastectomy or breast defect, type of TRAM flap used, operative technique, size and location of incisions, method of donor site closure, placement of any tissue expanders or implants, and any complications encountered.
** The information provided is current as of December 1, 2024, and may be subject to change with future updates to CPT coding guidelines.
- Revenue Code: P1A (Berenson-Eggers Type of Service: MAJOR PROCEDURE - BREAST)
- RVU: Refer to the Medicare Physician Fee Schedule (MPFS) for current RVUs.
- Global Days: Refer to payer guidelines
- Payment Status: Active
- Modifier TC rule: No
- Fee Schedule: Refer to historical Medicare Physician Fee Schedules (MPFS) for past payment rates.
- Specialties:Plastic Surgery, Reconstructive Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, and other facilities where breast reconstruction is performed