Summary & Overview
CPT 19300: Mastectomy for Gynecomastia
Headline: CPT 19300 — Mastectomy for Gynecomastia, Outpatient Surgical Procedure
Lead: CPT 19300 identifies mastectomy performed to treat gynecomastia, a common surgical approach to removing excess male breast tissue. The code captures a distinct outpatient mastectomy procedure that has implications for coverage, billing, and clinical documentation across major payers.
Overview: Nationally, CPT 19300 represents a targeted surgical intervention within plastic and reconstructive surgery and related specialties. It is relevant for surgeons, hospital billing teams, and payers because proper coding supports accurate claims processing, medical necessity review, and care continuity for patients seeking correction of gynecomastia. Key payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: This publication provides benchmarks for utilization and common billing practices, summarizes payer coverage contexts and authorization considerations, and outlines clinical context for the procedure. It highlights procedural scope and typical outpatient delivery, identifies common billing modifiers and related procedural codes, and lists relevant ICD-10 diagnoses associated with gynecomastia. Where specific operational data or service-line metadata are missing, the text notes "Data not available in the input."
CPT Code Overview
CPT 19300 describes mastectomy for gynecomastia, a surgical procedure to remove excess breast tissue in males. This procedure falls under the Mastectomy Procedures service type and is most commonly performed in an Outpatient Hospital (POS 22) setting. The code is used to document definitive surgical treatment for gynecomastia when tissue excision is indicated.
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to an outpatient hospital surgical clinic with unilateral enlargement of the male breast and tenderness. Clinical evaluation and history identify persistent gynecomastia despite conservative measures and trial of medical therapy. Imaging (ultrasound or mammography as indicated) excludes a suspicious mass. The patient elects surgical management and is scheduled for 19300 (mastectomy for gynecomastia) in an outpatient hospital setting (POS 22). Preoperative evaluation includes medical clearance by primary care (Family Medicine or Internal Medicine), laboratory assessment as indicated for comorbid conditions (for example hypothyroidism or hypopituitarism), and perioperative planning with the operating surgeon (Plastic and Reconstructive Surgery or Plastic Surgery). On the day of service, the procedure is performed under appropriate anesthesia, and documentation includes laterality, extent of tissue removal, intraoperative findings, and any concurrent procedures. Postoperative follow-up is arranged in the surgeon’s clinic with wound checks and instructions for activity restrictions and follow-up for underlying endocrine or metabolic conditions as indicated.
Coding Specifications
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Modifiers
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50- Bilateral Procedure: Use when mastectomy for gynecomastia is performed on both sides during the same operative session. -
LT- Left Side: Use when the procedure is performed only on the left breast. Documentation must clearly support laterality. -
RT- Right Side: Use when the procedure is performed only on the right breast. Documentation must clearly support laterality. -
59- Distinct Procedural Service: Use when a separate and distinct procedural service is performed at the same session that is not usually reported with19300; documentation must support distinctness. -
Provider Taxonomies
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208600000X- Plastic and Reconstructive Surgery: Surgeons who perform cosmetic and reconstructive breast procedures, including gynecomastia surgery. -
208200000X- Plastic Surgery: Surgeons providing operative management of breast tissue and contouring related to gynecomastia. -
207Q00000X- Family Medicine Physician: Primary care providers involved in evaluation, medical management, and preoperative clearance. -
207R00000X- Internal Medicine Physician: Specialists involved in medical evaluation and optimization of comorbid conditions prior to surgery. -
208800000X- Urology: Urologists who may be involved in evaluation of endocrine or medication-related causes of gynecomastia or perform surgery in certain practice settings. -
Service Type and Site
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Service Type: Mastectomy Procedures
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Typical Site of Service: Outpatient Hospital (POS 22)
Related Diagnoses
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N62- Gynecomastia- Clinical relevance: Primary indication for
19300; denotes benign enlargement of male breast tissue which can prompt surgical mastectomy when persistent or symptomatic.
- Clinical relevance: Primary indication for
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E66.9- Obesity, unspecified- Clinical relevance: May contribute to pseudogynecomastia or complicate perioperative risk assessment and surgical planning.
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E78.5- Hyperlipidemia, unspecified- Clinical relevance: Common comorbidity that may be present in patients undergoing evaluation; relevant for overall medical optimization and anesthesia risk.
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E03.9- Hypothyroidism, unspecified- Clinical relevance: Endocrine disorder that can be associated with changes in body habitus and may play a role in gynecomastia etiologies or medical management.
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E23.1- Hypopituitarism- Clinical relevance: Endocrine disorder that can cause hormonal imbalances leading to gynecomastia and is relevant to preoperative evaluation and long-term management.
Related CPT Codes
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19301- Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)- Relation: Represents a breast-conserving excision removing part of the breast tissue; may be an alternative when only a focal lesion requires excision rather than full mastectomy for gynecomastia.
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19303- Mastectomy, simple, complete- Relation: Represents a more extensive complete removal of breast tissue; may be used as an alternative or in situations where a more extensive mastectomy is clinically indicated.
19303is a related but distinct procedure and can be used instead of19300depending on surgical extent.
- Relation: Represents a more extensive complete removal of breast tissue; may be used as an alternative or in situations where a more extensive mastectomy is clinically indicated.
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Common concurrent or alternative use:
19301and19303are alternatives based on extent of tissue removal. Use of modifiers (for example50,LT,RT) applies to these related codes per laterality rules.
National Reimbursement Benchmarks
Medicare's national mean allowed rate of $656.74 is slightly below the BUCA (average commercial) mean of $681.62 for CPT 19300, indicating commercial payers on average reimburse a bit higher than Medicare. The absolute difference between Medicare and the BUCA commercial benchmark is $24.89.
Dispersion (P75 − P25) varies notably across payers. UnitedHealth Group shows the widest spread at $529.33 (P75 $1,054.33 − P25 $525.00), followed by Cigna at $482.25. Aetna is among the tightest with a spread of $148.71, and Medicare is also tight at $71.00. The table and chart below present the full percentile and mean breakdown for each national payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 19300, with the highest payer (Aetna) offering a mean rate of $2,123.70 and the lowest (Medicare) at $635.81. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($829.08) and BUCA ($749.96), indicating substantial variability among commercial payers. In contrast, Aetna's percentiles are tightly clustered, suggesting consistent rates across providers.
Compared to national averages, all commercial payers in Alaska reimburse at rates well above their national benchmarks, with Aetna's mean rate nearly four times the national mean. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 19300 in Alaska, with a mean rate of $2,123.70.
- Medicare is the lowest paying payer, with a mean rate of $635.81.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Aetna's mean rate nearly four times the national mean.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.