CPT 19081, 19083, 76645, 19806 - Biopsy of Breast

procedure code and description


19081 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance

19082 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)

19083 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance - average fee payment - $700 - $720

19084 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)

19085 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance


19086 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)


Breast Ultrasound

For characterization of a breast nodule the recommended CPT code is 76645 (Breast ultrasound).

For performing a line needle aspiration with imaging guidance use code 10022. A cyst drainage may be reported using 19000.

For breast biopsy, with placement of breast localization device(s) when performed and imaging of biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance use CPT code 19083 for the first lesion and if performed and +19084 for each additional lesion. Ultrasound guidance for these percutaneous procedures described above is included.

If performing a diagnostic breast ultrasound evaluation and an ultrasound guided needle procedure during the same patient encounter both codes may be billed: the diagnostic ultrasound (76645) and the ultrasound guided biopsy. Medicare CCI edits do not, at present, bundle the breast ultrasound and the ultrasound guidance of the biopsy, but some private payers may.

Breast

76645 Ultrasound Breast (unilateral or bilateral)

76880 Ultrasound Axilla

Bundled Services and Supplies and Modifiers 59 and XE, XP, XS, or XU

For dates of service on or after November 16, 2015, HCPCS code A4648 (tissue marker, implantable, any type, each) will not be eligible for separate reimbursement when reported with breast biopsy CPT codes 19081 – 19101 and/or placement of breast localization devices CPT codes 19281 – 19288. This information will be added to the Bundled Services and Supplies reimbursement policy. Modifiers will not override this edit therefore this information is also included in the Modifiers 59 and XE, XP, XS, & XU reimbursement policy.


Use of Modifiers

• indicating that only the professional service was provided, physicians must be attached to the CPT code for the ultrasound service. Payers will not reimburse physicians for the technical component in the hospital setting.

• If reporting a surgical procedure such as a biopsy on the same day E/M service must be “... above and beyond the usual preoperative and postoperative care associated with the procedure that was performed.” (CPT Assistant, May 2003.) Be sure to document in the patient’s record all components of the E&M service.



IDTF Table for CPT Codes 19081-19086

CPT Code Modifier Physician Supervision Level

19081  TC, 26 Ultrasound is bundled 2
19082 TC, 26 Ultrasound is bundled 2
19083 TC, 26 Ultrasound is bundled 2
19084 TC, 26 Ultrasound is bundled 2
19085 TC, 26 Ultrasound is bundled 2
19086  TC, 26 Ultrasound is bundled 2



Code NFAC Fee FAC Fee

10030
$614.61
$115.92

19081
$523.39
$132.54

19082
$428.83
$64.01

19083
$520.89
$124.38

19084
$423.33
$60.22

19085
$793.48
$145.35

19086
$640.57
$67.16



Reimbursement Guidelines Nonpalpable Breast Lesions

Effective January 1, 2003, Medicare covers percutaneous image-guided breast biopsy using stereotactic or ultrasound imaging for a radiographic abnormality that is nonpalpable and is graded as a BIRADS III, IV, or V. Palpable Breast Lesions Effective January 1, 2003, Medicare covers percutaneous image guided breast biopsy using stereotactic or ultrasound imaging for palpable lesions that are difficult to biopsy using palpation alone. Contractors have the discretion to decide what types of palpable lesions are difficult to biopsy using palpation.

CPT Code Description 

10022 Fine needle aspiration; with imaging guidance

19081 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance

19082 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)

19083 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance

19084 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)

19085 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance

19086 Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)



Non-Facility Payment Facility Payment APC Code APC Payment

10022 Fine needle aspiration; with imaging guidance $136.83 $64.67 0004 $320.01
19000 Puncture aspiration of cyst of breast $109.94 $43.70 0004 $320.01
19102 Biopsy of breast, percutaneous, needle core, using imaging guidance $212.05 $101.43 0005 $570.59
19103 Biopsy of breast, percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance $548.35 $189.59 0037 $1073.79
19290 Preoperative placement of needle localization wire, breast $159.64 $63.65 Packaged
Service No Payment
19295 Image guided placement of metallic localization clip or marker during biopsy $91.22 No Payment Packaged Service No Payment
60100 Biopsy, thyroid, percutaneous core needle $110.96 $78.97 0004 $320.01

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