Rmvl intact breast implant

CPT code 19328 is used when a surgeon removes a breast implant that is still intact (not ruptured or broken). This is different from removing a ruptured implant, which requires a different code.

Showing rates for

National Average

Base Medicare rate

$546.66

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

7.44

PE RVU (NF)

8.04

MP RVU

1.42

Total RVU

16.9

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Clearly document implant status as 'intact' in operative report. If any capsulectomy (partial or complete) is performed, consider codes 19371 or 19330 instead, which have higher RVUs and reimbursement.
Impact: Using 19371 for capsulectomy yields $793.57 (45% higher reimbursement) versus $546.66 for 19328
For bilateral procedures, append modifier 50 rather than billing two separate line items, as most payers require this approach for proper adjudication of paired organs.
Impact: Proper bilateral coding prevents denials and ensures approximately $820 total reimbursement versus risk of second side denial
Do not separately bill for implant pocket irrigation or drain placement as these are bundled services. However, if tissue expander is placed during same session, code 19357 may be separately billable.
Impact: 19357 adds $810.58 when appropriately documented as separate reconstructive stage
When performed with mastopexy (15877) or breast reduction (19318), ensure medical necessity is documented separately for each component to prevent denial of the implant removal as cosmetic.
Impact: Prevents denial of $546.66 claim when combined procedures raise cosmetic flags in payer systems
Submit operative report with initial claim for procedures requiring modifier 22 or when implant age exceeds 20 years, as these often trigger automatic review.
Impact: Reduces processing time by 15-30 days and decreases likelihood of automatic denial requiring appeal
Verify pre-authorization requirements specific to implant removal, as many commercial payers classify this differently than initial placement and may not require authorization even when placement did.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19328 in 2025?

The 2025 Medicare national average reimbursement for CPT 19328 is $546.66 for both facility and non-facility settings. This is based on 16.9 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments for your area.

What is the difference between CPT 19328 and 19330?

CPT 19328 is for removal of an intact breast implant only, while CPT 19330 describes removal of a ruptured breast implant. Code 19330 has higher RVUs (20.79 vs 16.9) and reimbursement ($672.54 vs $546.66) because ruptured implant removal typically requires more extensive dissection, irrigation, and removal of extravasated implant material. Documentation must clearly support implant status.

Can I bill CPT 19328 with a capsulectomy code?

No, CPT 19328 should not be billed with capsulectomy codes 19371 (periprosthetic capsulectomy) or complete capsulectomy codes. If significant capsular work is performed, use 19371 instead of 19328. Code 19328 assumes only minimal capsular manipulation necessary to remove the intact implant. Billing both creates unbundling issues and will result in denial of one code.

How do I bill for bilateral breast implant removal?

For bilateral intact implant removal, report CPT 19328 with modifier 50 (bilateral procedure) on a single line, or report two line items with modifiers RT and LT, depending on payer requirements. Most Medicare contractors and commercial payers prefer modifier 50. Bilateral reimbursement is typically 150% of the unilateral rate, approximately $819.99 for Medicare.

Is CPT 19328 covered by Medicare and insurance?

CPT 19328 is covered by Medicare and most commercial insurance when medically necessary. Common covered indications include capsular contracture, implant malposition, infection, implant integrity concerns, or pain. Cosmetic removal (patient preference without medical indication) is typically not covered. Pre-authorization requirements vary by payer, so verify coverage before scheduling.

What modifiers are commonly used with CPT 19328?

Common modifiers for 19328 include: 50 (bilateral procedure), RT/LT (right/left side), 58 (staged procedure during global period), 78 (return to OR for complication), and 22 (increased procedural services for unusual complexity). Modifier selection depends on the specific clinical scenario and operative circumstances. Incorrect modifier use is a frequent cause of claim denials.

Can CPT 19328 be billed with breast implant replacement codes?

Yes, when performing implant exchange (removal and replacement in same session), bill both CPT 19328 (removal of intact implant) and CPT 19342 (insertion of new implant) or 19340 (immediate insertion). Both codes are separately billable as they represent distinct surgical work. However, if capsulectomy is also performed, this may change coding to 19370 or other combination codes. Review NCCI edits for your specific combination.