CPT Code Overview

CPT 19318: Reduction mammoplasty is a surgical procedure to reduce breast size by removing excess breast tissue, fat, and skin to achieve a breast size in proportion with the body and to alleviate symptoms associated with macromastia. This code is categorized under Plastic Surgery and is typically performed in an Outpatient Hospital (POS 22) setting.

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Clinical Context

A 38-year-old female presents to a plastic surgery clinic with symptomatic breast hypertrophy causing back, neck, and shoulder pain and skin irritation beneath the inframammary fold. Nonoperative management including physical therapy and analgesics provided limited relief. After evaluation by a board-certified plastic surgeon, the patient elects to undergo 19318 (reduction mammoplasty) on an outpatient hospital day-surgery basis (POS 22). Preoperative steps include history and physical, photographic documentation, marking of reduction pattern, informed consent, and pre-anesthesia evaluation. On the day of surgery the procedure is performed under general anesthesia with tissue resection, reshaping of the breast mound, and nipple-areolar complex repositioning. Typical postoperative workflow includes routine recovery in the ambulatory PACU, discharge with wound care and activity restrictions, and scheduled outpatient follow-up for suture removal and assessment of healing. Aftercare visits for resolution of pain or wound issues are coded separately as applicable.

Coding Specifications

Modifier usage and definitions:

• 50 - Bilateral Procedure

• Use when a bilateral 19318 reduction mammoplasty is performed and a bilateral billing indicator is required.

• RT - Right Side

• Use to identify a procedure performed on the right breast when single‑side reporting is required.

• LT - Left Side

• Use to identify a procedure performed on the left breast when single‑side reporting is required.

• 59 - Distinct Procedural Service

• Use when an additional procedure performed during the same operative session is distinct and separate from the reduction mammoplasty per payer rules.

Associated provider taxonomies and specialties:

• 208200000X - Plastic Surgery

• Represents physicians and surgeons specializing in reconstructive and aesthetic procedures, including reduction mammoplasty.

• 2086S0122X - Surgery of the Hand

• Represents surgeons with a hand surgery focus; may be listed when a provider holds this additional taxonomy but is not the typical specialty for breast reduction.

• 2086X0206X - Surgical Oncology

• Represents surgical oncologists; may be involved when oncologic indications or concurrent cancer-related procedures affect breast surgery coding.

Related Diagnoses

• N62 - Hypertrophy of breast

• Clinical relevance: Primary indication for 19318; symptomatic breast enlargement leading to reduction surgery.

• L26 - Exfoliative dermatitis

• Clinical relevance: Generalized skin conditions may affect perioperative skin integrity or indicate dermatologic comorbidity affecting surgical planning.

• L30.4 - Erythema intertrigo

• Clinical relevance: Intertrigo beneath the breast folds can be a symptomatic reason supporting reduction to alleviate skin irritation.

• L53.8 - Other specified erythematous conditions

• Clinical relevance: Non‑specific erythematous skin findings that may contribute to symptoms addressed by reduction surgery.

• L54 - Erythema in diseases classified elsewhere

• Clinical relevance: Skin erythema related to systemic disease that could influence surgical risk or postoperative wound healing.

• L95.1 - Erythema elevatum diutinum

• Clinical relevance: Rare dermatologic condition; relevant when skin disease affects breast skin and surgical decision‑making.

• L98.9 - Disorder of the skin and subcutaneous tissue, unspecified

• Clinical relevance: Non‑specific skin/subcutaneous disorders that may be documented as comorbidities in the surgical record.

• M25.511 - Pain in right shoulder

• Clinical relevance: Musculoskeletal pain linked to breast hypertrophy posture strain; supports functional necessity for reduction.

• M25.512 - Pain in left shoulder

• Clinical relevance: Same as M25.511 for the contralateral side; documents functional impact.

• M54.2 - Cervicalgia

• Clinical relevance: Neck pain that may be aggravated by large breasts, supporting medical necessity documentation.

• M54.6 - Pain in thoracic spine

• Clinical relevance: Back pain associated with breast hypertrophy and posture; commonly cited functional indication.

• M54.89 - Other dorsalgia

• Clinical relevance: Additional dorsalgia codes that document spine/back pain related to breast size.

• N64.1 - Fat necrosis of breast

• Clinical relevance: Local breast pathology that may be evaluated during reduction or influence the operative plan.

• N64.81 - Ptosis of breast

• Clinical relevance: Breast ptosis is frequently addressed during reduction mammoplasty as part of aesthetic and functional reshaping.

• N65.1 - Disproportion of reconstructed breast

• Clinical relevance: Relevant in reconstructive cases where asymmetry or disproportion may prompt revisionary reduction procedures.

• O91.211 - Nonpurulent mastitis associated with pregnancy, first trimester

• Clinical relevance: Pregnancy‑associated breast inflammation that may be part of the preoperative history; timing affects surgical planning.

• O91.212 - Nonpurulent mastitis associated with pregnancy, second trimester

• Clinical relevance: Same considerations as O91.211 for second trimester.

• O91.213 - Nonpurulent mastitis associated with pregnancy, third trimester

• Clinical relevance: Same considerations as other pregnancy‑associated mastitis codes for third trimester.

• R21 - Rash and other nonspecific skin eruption

• Clinical relevance: Cutaneous findings that may be documented as comorbid skin conditions impacting perioperative care.

• Z48.3 - Aftercare following surgery for neoplasm

• Clinical relevance: Codes postoperative care visits following oncologic breast surgery; may be used when reduction occurs in the context of cancer aftercare.

Related CPT Codes

Common pairings and alternatives:

• 19316 is commonly considered when the primary goal is lifting rather than volume reduction; it may be chosen instead of 19318.

• 19340 and 19357 are commonly used in reconstructive pathways and can appear during the same episode of care when oncology or prior reconstruction factors are present.

• 19303 is an alternative in oncologic indications and is not typically combined with elective reduction coding.

• When bilateral work is performed, 50 is commonly appended to 19318; RT/LT are used when billing laterality instead of or in addition to bilateral modifiers per payer requirements.

Medicare mean allowed rate for CPT 19318 ($997.40) sits below the BUCA (average commercial) mean ($1,436.89), reflecting lower national reimbursement from the government payer relative to the commercial aggregate. The gap between Medicare and BUCA is $439.49 in mean rate.

Rate dispersion (P75 − P25) varies across payers: UnitedHealth Group shows the widest spread at $1,144.00 (P75 $2,342.00 − P25 $1,198.00), followed by Cigna with $1,051.50, while Medicare is the tightest at $74.00. Aetna has a dispersion of $729.13, Blue Cross Blue Shield $663.93, and BUCA $797.96. The table and chart below present the full breakdown of mean rates and percentiles for each payer.