CPT code 19303 reserved for treatment or prevention of breast cancer effective November 18, 2026

In accordance with American Medical Association (AMA) guidance, CPT code 19303 (Mastectomy, Simple/Complete) is intended for the treatment or prevention of breast cancer and will be added to the list of applicable non-covered codes under the medical policy Sex Trait Modification Procedures for Gender Affirming Care effective November 18, 2026.

Why is this change happening

In alignment with guidance from the AMA and industry coding standards, CPT code 19303 should not be reported for reduction mammaplasty or subcutaneous mastectomy performed as part of female-to-male gender-affirming chest surgery.

When breast tissue is removed for chest contouring or breast-size reduction rather than for the treatment or prevention of breast cancer, CPT code 19318 (Reduction Mammaplasty) is generally the more appropriate code to report.

Additional guidance

This notification is provided for coding guidance purposes only and does not determine coverage, medical necessity, benefit eligibility, or reimbursement.

This change applies to Commercial and Inter-Plan Program (IPP) Home plans. This does not apply to the Federal Employee Program (FEP), IPP Host, or Medicare Advantage plans.