Rmvl ruptured breast implant

CPT code 19330 covers the surgical removal of a ruptured breast implant. This procedure is performed when a breast implant has broken or leaked and needs to be taken out to prevent complications.

Showing rates for

National Average

Base Medicare rate

$635.61

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

PE RVU (NF)

8.95

MP RVU

1.7

Total RVU

19.65

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

NCCI bundling edits

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Billing tips

Document rupture confirmation method (imaging, intraoperative findings) explicitly in operative note
Impact: Prevents denials for lack of medical necessity; rupture documentation justifies use of 19330 over routine removal code 19328, protecting the $635.61 reimbursement
Bill 19330 separately from implant replacement (19340 or 19342) when both are performed - these are distinct procedures
Impact: Ensures payment for both removal ($635.61) and replacement procedures separately, potentially adding $800-1200 in additional reimbursement
For bilateral ruptured implant removal, verify payer-specific modifier 50 policies before billing
Impact: Some payers require two line items with RT/LT instead of modifier 50; incorrect format causes processing delays and potential $317.81 underpayment per side
Use modifier 22 with detailed operative report when extensive capsulectomy or silicone granuloma removal significantly increases surgical time beyond typical 60-90 minutes
Impact: Can increase reimbursement by $127-191 (20-30%) when properly documented with comparison to standard procedure complexity
Verify pre-authorization requirements for commercial payers even though Medicare does not require PA for 19330
Impact: Commercial payers often require PA for all breast implant procedures; failure to obtain can result in 100% denial ($635.61 loss)
Code capsulectomy separately only if performed beyond what is necessary to remove the ruptured implant (use 19371 for periprosthetic capsulectomy)
Impact: Complete capsulectomy may warrant additional $400-600 when medically necessary and documented, but routine capsule work is included in 19330

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19330 in 2025?

The 2025 Medicare national average reimbursement for CPT 19330 is $635.61 for both facility and non-facility settings. This rate is based on 19.65 total RVUs (9.0 work RVU, 8.95 practice expense RVU, 1.7 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 19330 and 19328?

CPT 19330 is specifically for removal of a ruptured breast implant, while 19328 covers removal of an intact implant. The key distinction is whether the implant has ruptured or leaked. Documentation must clearly support rupture to justify using 19330, typically through pre-operative imaging and intraoperative findings.

Can I bill CPT 19330 with implant replacement on the same day?

Yes, CPT 19330 (ruptured implant removal) can be billed separately from implant replacement codes (19340 for insertion of breast prosthesis on same day as mastectomy, or 19342 for delayed insertion). These are distinct procedures and should be coded separately, though you may need modifier 59 to prevent bundling by some payers.

What modifier should I use for bilateral ruptured implant removal?

For bilateral ruptured implant removal, use modifier 50 (bilateral procedure) with most payers, which typically reimburses at 150% of the unilateral rate. However, some payers require two separate line items with RT (right) and LT (left) modifiers instead. Always verify payer-specific billing guidelines before submitting.

Does CPT 19330 include capsulectomy or is that billed separately?

CPT 19330 includes routine capsular work necessary to remove the ruptured implant. However, if a complete periprosthetic capsulectomy is performed beyond what is typical for implant removal, you may separately report CPT 19371 with appropriate documentation justifying the additional work and medical necessity.

What diagnosis codes support medical necessity for CPT 19330?

Primary diagnosis codes include T85.41XA (breakdown/rupture of breast prosthesis and implant, initial encounter), T85.42XA (displacement of breast prosthesis), M96.89 (other postprocedural complications), or T85.79XA (infection and inflammatory reaction). The specific ICD-10 code should reflect the documented complication requiring removal.

How many RVUs is CPT code 19330 worth in 2025?

CPT 19330 has a total of 19.65 RVUs in 2025, consisting of 9.0 work RVUs, 8.95 practice expense RVUs (both facility and non-facility), and 1.7 malpractice RVUs. This relatively high RVU value reflects the surgical complexity and risk involved in removing ruptured implants and managing leaked material.