2025 CPT code 19281
(Active) Effective Date: N/A Revision Date: N/A Surgery - Introduction Procedures on the Breast Surgery Feed
Percutaneous placement of a breast localization device (e.g., clip, pellet, wire, needle, or radioactive seeds) for the first lesion, using mammographic guidance.
Modifiers may be applicable depending on the specific circumstances of the procedure.Consult the CPT manual for guidance.
Medical necessity is established when imaging demonstrates a suspicious breast lesion requiring localization before biopsy or surgery. The procedure improves the accuracy of targeting the lesion, minimizing complications and improving patient outcomes.
The physician is responsible for the pre-procedural assessment, image interpretation, device placement, post-procedural assessment and follow-up care.
In simple words: The doctor uses a mammogram (breast X-ray) to find a suspicious area in the breast.A small device is then placed at that spot to make it easier to find during a biopsy or surgery.
This CPT code describes the percutaneous placement of a single breast localization device under mammographic guidance.The procedure involves using mammography to identify the lesion's precise location, then using a minimally invasive technique to place the localization device (clip, metallic pellet, wire, needle, or radioactive seeds) at the target site. Post-placement, a mammogram confirms correct positioning. This is typically done to mark a lesion before biopsy or surgery.
Example 1: A patient presents with a suspicious mammographic finding.The physician performs a mammographically guided percutaneous placement of a localization clip to mark the lesion before a subsequent surgical excisional biopsy., A patient undergoes a stereotactic breast biopsy.Prior to the biopsy, a percutaneous placement of a localization wire is performed using mammographic guidance, coded 19281., A patient has a palpable breast mass. Ultrasound is used to guide percutaneous placement of a radioactive seed for localization prior to surgical excision.
* Pre-operative and post-operative imaging (mammogram)* Accurate description of the device used (e.g., clip, seed, wire)* Lesion location clearly marked on the imaging* Documentation of the procedure performed and any complications* Consent form signed by the patient
** This code should only be used for the initial lesion localization using mammographic guidance.Appropriate add-on codes or alternative primary codes should be utilized for additional lesions and alternative imaging modalities.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: The RVUs vary based on the year and location of service.Consult the current Medicare Physician Fee Schedule for the most accurate data. Example: In 2021, the national average Medicare rate for the professional component in an office/freestanding setting was $252.63, with a relative value unit of 7.24. The facility component had a rate of $100.49 and a relative value unit of 2.88.
- Global Days: Global period details are not explicitly defined for this code.It's considered a global procedure; the post-operative care is included.
- Payment Status: Active
- Modifier TC rule: The professional component is typically reported with 19281; the technical component may be reported separately (depending on the facility and payer guidelines).
- Fee Schedule: Fee schedules vary by payer and year.Refer to historical fee schedules for specific years.
- Specialties:Surgery (breast), radiology (diagnostic)
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center