CPT 19318Out-of-network reimbursement & IDR outcomes
Breast reduction
MedRes analysis of CMS public-use files · Released Jul 22, 2026 · Updated Sep 17, 2026
Sources & methodologyThis cohort covers breast-reduction services that reached federal IDR. Eligibility depends on the claim and facility context; an elective procedure code alone is insufficient.
Compare determinations by region
Historical out-of-network payment determinations, with initial payments shown separately. Dollar records do not identify the payer.
25th–75th percentile · not a predicted range
Summary follows setting, geography and decision filters. Text search filters table rows only. All reported modifiers pooled.
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8 regions · minimum cohort: 11 line items
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| GEOGRAPHIC REGION | MEDIAN DETERMINATION | MIDDLE 50% | INITIAL PAYMENT | VALID AWARDS |
|---|---|---|---|---|
| New York-Newark-Jersey City, NY-NJ-PAReported geographic region | $75,000n = 564 | $30,000 – $120,000 | $1,228n = 412 | 564 |
| Region not reportedReported geographic region | $124,599n = 73 | $68,850 – $194,628 | $1,808n = 30 | 73 |
| Bridgeport-Stamford-Norwalk, CTReported geographic region | $90,000n = 30 | $44,900 – $149,000 | Not availablen = 8 | 30 |
| Hartford-East Hartford-Middletown, CTReported geographic region | $90,000n = 21 | $75,000 – $150,000 | Not availablen = 7 | 21 |
| Miami-Fort Lauderdale-Pompano Beach, FLReported geographic region | $72,000n = 12 | $5,873 – $132,750 | Not availablen = 5 | 12 |
| Richmond, VAReported geographic region | $60,172n = 12 | $22,500 – $158,000 | $1,858n = 12 | 12 |
| Albany-Schenectady-Troy, NYReported geographic region | $183,882n = 11 | $43,500 – $195,000 | Not availablen = 9 | 11 |
| Trenton-Princeton, NJReported geographic region | $89,952n = 11 | $37,875 – $97,314 | Not availablen = 5 | 11 |
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A determination is the selected out-of-network payment amount, not additional recovery or verified cash received. Initial-payment and determination medians may use different observations. Small cohorts are omitted; totals can exceed the visible rows. Read the methodology.
What this data can tell you
Compare the distribution of reported outcomes, the number of observations behind them, and differences between service settings. Every metric here comes from published federal IDR records; it is independent of MedRes client performance.
Keep the claim context in view
These are selected disputes that reached a determination. Awards are not verified collections. CPT codes alone do not establish eligibility, and professional, technical and other modifiers are pooled in this release.
Review eligibility factorsReading the benchmarks
What is the reported IDR payment for CPT 19318?
For Q4 2025 closures, the median prevailing offer was $79,560 across 734 usable single or batched line-item awards. This national summary pools settings and reported modifiers. It describes determinations, not verified collections or guaranteed reimbursement.
Can I see what each payer paid for CPT 19318?
The public dollar file does not identify payers or provide dispute identifiers for a reliable join. The payer view therefore uses reported award-to-QPA ratios and selection outcomes, not payer-specific dollar payments.
Does CPT 19318 qualify for federal IDR?
A CPT code alone does not establish eligibility. Service category, facility network status, plan type, claim state and timing must be reviewed. These records are a selected population of federal payment determinations.
Related procedure benchmarks
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