2025 CPT code 19302
(Active) Effective Date: N/A Revision Date: N/A Surgery - Mastectomy Procedures Surgery Feed
Partial mastectomy (lumpectomy, tylectomy, quadrantectomy, or segmentectomy) with axillary lymphadenectomy.
Modifier 50 (Bilateral Procedure) should be used for bilateral procedures. Other modifiers may apply depending on the circumstances of the procedure.
The medical necessity for a partial mastectomy with axillary lymph node dissection is established by the presence of a suspicious breast mass, palpable lump, abnormal mammographic findings, or a biopsy confirming breast cancer. Prophylactic procedures may be medically necessary in high-risk patients.
The surgeon is responsible for performing the incision, removing the breast tissue and lymph nodes, placing a drain, closing the wound, and applying a dressing.Pathology then analyzes the removed tissue to confirm the diagnosis and staging of the cancer.
In simple words: The surgeon removes part of the breast (a lumpectomy, tylectomy, quadrantectomy, or segmentectomy) and some lymph nodes under the arm during this surgery. This is done to treat or prevent breast cancer.
This CPT code, 19302, describes a partial mastectomy, which includes the removal of a portion of breast tissue (such as a lumpectomy, tylectomy, quadrantectomy, or segmentectomy), along with the removal of axillary lymph nodes.The procedure is performed for the treatment or prevention of breast cancer.It's crucial to note that this code encompasses the removal of lymph nodes from the axilla as part of the same surgical procedure.Separate billing for lymph node removal is not appropriate when it is performed concurrently with a partial mastectomy.
Example 1: A 45-year-old female presents with a suspicious mass in her right breast.A partial mastectomy (lumpectomy) with axillary lymph node dissection is performed to remove the mass and assess for lymph node involvement. Code 19302 is reported., A 60-year-old female undergoes a quadrantectomy of her left breast with axillary lymph node removal due to the presence of invasive ductal carcinoma.Code 19302 is reported., A 52-year-old female with a high risk of developing breast cancer elects a prophylactic partial mastectomy (tylectomy) with axillary lymph node dissection in her right breast.Code 19302 is reported.
Surgical notes detailing the type of partial mastectomy performed (lumpectomy, tylectomy, quadrantectomy, or segmentectomy), extent of resection, number of lymph nodes removed, pathology report confirming the diagnosis and the presence or absence of metastasis.Preoperative imaging (mammography, ultrasound, MRI) should also be documented.
** Intraoperative placement of clips is not separately reported.For placement of radiotherapy afterloading balloon/brachytherapy catheters, see codes 19296-19298. For the preparation of the tumor cavity with placement of an intraoperative radiation therapy applicator concurrently with partial mastectomy, use code 19294. For radiofrequency spectroscopy, real-time, intraoperative margin assessment at the time of partial mastectomy with report, use code 0546T. For 3-dimensional volumetric specimen imaging, use code 0694T.
- Revenue Code: P1A (Major Procedure - Breast)
- RVU: This information is not provided and varies based on geographic location and payer.
- Global Days: The global period for this procedure is not specified in the provided text and varies according to payer and local coverage determination.
- Payment Status: Active
- Modifier TC rule: Not applicable; the entire procedure is covered under code 19302.
- Fee Schedule: This information is not available in the provided sources and varies by payer and geographic location. It's crucial to consult the most up-to-date fee schedules and local coverage determinations.
- Specialties:Surgical Oncology, General Surgery, Breast Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital