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2025 CPT code 19301

Partial mastectomy (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy).

Adhere to CPT guidelines for mastectomy procedures. Accurate documentation is critical for proper code selection and reimbursement.

Modifier 50 is used for bilateral procedures. Other modifiers may be applicable depending on the circumstances of the procedure.

Medical necessity is established by a documented diagnosis of breast cancer or pre-cancerous lesions requiring surgical removal to treat or prevent further growth and spread of disease.Imaging and biopsy findings should support the need for surgery.

The surgeon's responsibilities include incising the breast skin over the suspicious area, excising the lump or significant portion of the breast tissue with margins, checking and removing any additional lesions, placing a drain, closing the wound, and applying a dressing.

IMPORTANT:If a complete axillary lymphadenectomy is also performed, report code 19302. If the procedure is for breast reduction (not cancer), use code 19318. For bilateral procedures, use modifier 50.

In simple words: This code is for surgery to remove part of a breast, but not the whole breast.This might be a lumpectomy, tylectomy, quadrantectomy, or segmentectomy.It's done to treat or prevent breast cancer.

This CPT code 19301 describes a partial mastectomy, which involves the removal of a portion of the ipsilateral breast tissue.This can include procedures such as lumpectomy, tylectomy, quadrantectomy, or segmentectomy. The procedure is performed for the treatment or prevention of breast cancer.It does not include the removal of axillary lymph nodes; if those are removed, code 19302 should be used instead.If the breast tissue is removed for breast reduction (not cancer treatment), code 19318 should be reported.

Example 1: A 45-year-old female patient presents with a palpable lump in her right breast.Biopsy confirms invasive ductal carcinoma.A lumpectomy (partial mastectomy) is performed to remove the tumor and surrounding tissue. Code 19301 is reported., A 52-year-old female patient undergoes a quadrantectomy (partial mastectomy) of the left breast due to ductal carcinoma in situ.No axillary lymph node dissection was performed.Code 19301 is reported., A 60-year-old female patient presents with a large fibroadenoma in her right breast causing significant cosmetic concerns.The surgeon performs a partial mastectomy for reduction purposes.In this case, code 19318 (reduction mammaplasty), not 19301, would be used.

Detailed operative report including the type of partial mastectomy performed (lumpectomy, quadrantectomy, etc.), dimensions of excised tissue, pathology report confirming the diagnosis, and images of the surgical site.

** Ensure accurate documentation of the surgical procedure and pathology results.Consider using additional codes to report associated procedures such as sentinel lymph node biopsy.

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