Denial - 19371

Question:

We received a denial for 19371 when billed with 19342 for an implant exchange to a smaller implant. Is the denial correct?

Answer:

This is a great question and a common scenario.

While coding guidance indicates that code 19371 may be reported in addition to code 19342, this is considered correct coding under CPT rules.

However, Medicare’s National Correct Coding Initiative (NCCI) bundles 19371 into 19342. Additionally, modifier 59 should not be appended to 19371 to bypass the NCCI edit when both procedures are performed on the same breast. The denial is correct when billing Medicare or payers that follow NCCI edits.

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*This response is based on the best information available as of 02/05/26.