Summary & Overview
CPT 19324: Mammaplasty Augmentation Without Prosthetic Implant
CPT code 19324 covers mammaplasty, augmentation without prosthetic implant, a specialized plastic surgery procedure aimed at enhancing breast size and contour without the use of artificial implants. This code is significant in both cosmetic and reconstructive contexts, addressing patient needs such as breast hypertrophy, pain, post-mastectomy reconstruction, and personal history of breast cancer. The procedure is typically performed in outpatient hospital settings, reflecting current clinical practice trends.
Key payers included in this analysis are Blue Cross Blue Shield and Cigna Health, two major national insurers with broad coverage for plastic and reconstructive surgery services. Readers will gain insight into payer coverage policies, common clinical indications, and relevant coding benchmarks for 19324. The publication also highlights associated ICD-10 diagnoses, related CPT codes for breast surgery, and the use of modifiers such as 51 and 59 for billing multiple or distinct procedures.
This summary provides a comprehensive overview of the clinical and billing landscape for mammaplasty augmentation without prosthetic implant, equipping stakeholders with essential information for policy review, coding accuracy, and understanding payer requirements.
CPT Code Overview
CPT code 19324 describes mammaplasty, augmentation without prosthetic implant, a surgical procedure performed to enhance the size and shape of the breast using techniques that do not involve the placement of an artificial implant. This procedure falls under the plastic surgery service type and is commonly performed in an outpatient hospital setting (Place of Service 22). It is utilized for patients seeking breast augmentation for cosmetic or reconstructive purposes without the use of prosthetic devices.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult female presenting to a plastic surgeon with concerns about breast size or shape, often due to hypertrophy, pain, or cosmetic reasons. The patient may have a history of breast cancer, prior mastectomy, or simply desire cosmetic enhancement. After evaluation, the surgeon determines that mammaplasty augmentation without prosthetic implant (CPT code 19324) is appropriate. The procedure is performed in an outpatient hospital setting (Place of Service 22), and the clinical workflow includes preoperative assessment, surgical planning, and postoperative follow-up.
Coding Specifications
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Modifiers:
- Modifier
51: Used when multiple procedures are performed during the same operative session. Indicates thatCPT code 19324is one of several procedures. - Modifier
59: Used to denote a distinct procedural service, indicating thatCPT code 19324is separate from other procedures performed on the same day.
- Modifier
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Provider Taxonomies:
- Plastic and Reconstructive Surgery: Represents board-certified plastic surgeons specializing in reconstructive and cosmetic procedures of the breast and other body areas.
Related Diagnoses
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N62- Hypertrophy of breast: Indicates excessive breast tissue, which may prompt surgical intervention for augmentation or reduction. -
N64.4- Mastodynia: Refers to breast pain, which can be a symptom leading to consideration of surgical procedures. -
Z42.1- Encounter for breast reconstruction following mastectomy: Used when the procedure is part of reconstructive surgery after breast removal due to cancer or other conditions. -
Z41.1- Encounter for cosmetic surgery: Indicates the procedure is performed for cosmetic reasons, such as enhancement of breast appearance. -
Z85.3- Personal history of malignant neoplasm of breast: Relevant for patients with a history of breast cancer, often requiring reconstructive or augmentation procedures.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
19318 | Reduction mammaplasty | Alternative procedure for patients seeking reduction rather than augmentation. |
19325 | Breast augmentation with implant | Used when augmentation is performed with a prosthetic implant, as opposed to 19324 which is without implant. |
19340 | Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction | Related to reconstructive workflows, often following mastectomy or mastopexy. |
19357 | Breast reconstruction, immediate or delayed, with tissue expander | Used in breast reconstruction scenarios, often after mastectomy, and may be part of a staged approach. |
CPT code 19318andCPT code 19325are commonly used as alternatives depending on patient goals.CPT code 19340andCPT code 19357are typically used in reconstructive workflows, sometimes in conjunction with or instead ofCPT code 19324.
National Reimbursement Benchmarks
Nationally, commercial mean rates for CPT code 19324 vary significantly. The average rate for Blue Cross Blue Shield is $628.58, while BUCA (average commercial) stands at $919.03. Cigna's mean rate is notably higher at $1,343.31. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($754.50), followed by BUCA ($433.00), and is tightest for Blue Cross Blue Shield ($210.50). This indicates that Cigna's rates are more variable across providers, while Blue Cross Blue Shield's rates are more consistent.
The table and chart below present the full breakdown of national benchmarks for these payers.
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.