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CPT code 19340 covers the surgical insertion of a breast implant during or after a mastectomy, typically as part of breast reconstruction following cancer treatment or prophylactic mastectomy.

Showing rates for

National Average

Base Medicare rate

$746.88

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

10.48

PE RVU (NF)

10.56

MP RVU

2.05

Total RVU

23.09

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

NCCI bundling edits

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Billing tips

Clearly distinguish 19340 (immediate implant) from 19357 (delayed tissue expander/implant) in operative documentation to prevent code confusion
Impact: Prevents downcoding and denials; 19357 reimburses at $844.21, a $97.33 difference per side
For bilateral procedures, use modifier 50 or bill twice with RT/LT modifiers depending on payer preference; verify with individual contracts
Impact: Ensures full bilateral reimbursement of approximately $1,120.32 rather than single-side $746.88
Document medical necessity clearly including cancer diagnosis, BRCA status, or prophylactic indication with supporting pathology/genetic testing to satisfy WHCRA requirements
Impact: Reduces denial rate by 30-40% for federal and commercial payers with mandatory coverage provisions
When performed with mastectomy on same date, ensure separate documentation for reconstruction component and link to appropriate ICD-10 codes (Z42.1 for aftercare, Z90.1- for breast absence status)
Impact: Prevents bundling denials and supports medical necessity; maintains separate payment for both procedures
For ASC settings, verify implant costs are separately billable under payer contract; implant supply costs typically $1,500-$3,000 and may require specific HCPCS codes
Impact: Recovers $1,500-$3,000 in implant device costs beyond the $746.88 professional fee
Use modifier 22 with detailed operative report when radiation damage, prior infection, or complex anatomy requires significantly extended time (document time comparisons and specific challenges)
Can increase reimbursement by 20-50% ($149-$373 additional) when properly documented and appealed

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19340 in 2025?

The 2025 Medicare national average reimbursement for CPT 19340 is $746.88 for both facility and non-facility settings, based on 23.09 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 19340 be billed with a mastectomy code on the same day?

Yes, CPT 19340 is separately reportable when performed with mastectomy codes (19301-19307) as immediate breast reconstruction. Ensure separate documentation for the reconstruction component and verify no local coverage determination (LCD) bundling edits apply to your MAC region.

What is the difference between CPT 19340 and 19357?

CPT 19340 covers insertion of a permanent breast implant during immediate or single-stage reconstruction, while 19357 describes insertion of a tissue expander or implant as part of staged reconstruction. Code 19357 is used when exchange or expansion is anticipated, reimbursing at $844.21 versus 19340's $746.88.

How do I bill CPT 19340 for bilateral breast reconstruction?

For bilateral implant reconstruction, append modifier 50 to CPT 19340 or bill the code twice with RT and LT modifiers, depending on payer requirements. Medicare typically accepts modifier 50 and reimburses at 150% ($1,120.32 total). Verify bilateral payment policies with commercial payers as some may pay 100% for each side.

Is breast reconstruction with CPT 19340 covered by insurance?

Yes, the Women's Health and Cancer Rights Act (WHCRA) of 1998 federally mandates coverage of breast reconstruction following mastectomy for all group health plans and individual policies. This includes the implant procedure (19340), contralateral procedures for symmetry, and treatment of complications. Prior authorization may still be required.

What documentation is required to bill CPT 19340?

Required documentation includes a detailed operative report specifying implant type/size/manufacturer, medical necessity with cancer diagnosis or genetic risk documentation, clear laterality designation, pocket creation technique, separate reconstruction work if performed with mastectomy, patient consent, and any complexity factors justifying modifiers.

What are the work RVUs for CPT code 19340?

CPT 19340 has 10.48 work RVUs, 10.56 practice expense RVUs (both facility and non-facility), and 2.05 malpractice RVUs, totaling 23.09 RVUs for 2025. This reflects the significant surgical complexity and physician work involved in breast implant reconstruction.