2025 CPT code 19086
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Breast Surgery Feed
Percutaneous biopsy of each additional breast lesion after the first, separately reported lesion, with magnetic resonance guidance; includes localization device placement and specimen imaging, if performed.
Modifiers may apply depending on the circumstances of the procedure and payer requirements.Examples include modifiers for anesthesia (e.g., 47), reduced services (52), or repeat procedures (76).
The medical necessity for additional biopsies is determined by the presence of suspicious lesions identified on pre-procedure imaging that warrant further evaluation.The clinical findings (size, location, characteristics of the lesions) and the patient’s medical history should support the decision to perform these additional biopsies. The need for the additional biopsies must be documented clearly in the medical record.
The physician is responsible for performing the percutaneous biopsy under magnetic resonance guidance, including making the small incision, removing tissue from the additional breast lesion, potentially placing localization devices, imaging the specimen, and applying pressure and bandages at the incision site.The physician must ensure the procedure is medically necessary and appropriately documented.
In simple words: This code covers a breast biopsy procedure where a doctor takes a tissue sample from an extra breast area after already doing a biopsy in another part of the breast. This uses special imaging called magnetic resonance to precisely guide the needle. The doctor might also put in a tiny marker and check the sample on imaging. The procedure is done in the same visit as the first biopsy.The code is used once for each extra breast tissue sample taken.
This CPT code reports percutaneous biopsy of each additional breast lesion under magnetic resonance guidance, following a separately reported initial breast lesion biopsy.The procedure includes the removal of tissue from an additional breast lesion during the same session as the initial biopsy.It may also include placement of one or more localization devices and imaging of the specimen. Pressure and bandages are applied to the incision site following tissue removal.This code is reported once for each additional lesion biopsied.Localization device placement and specimen imaging are included if performed, but not required for code reporting.
Example 1: A patient presents with multiple suspicious breast lesions identified on MRI.The physician performs a core needle biopsy of the largest lesion (coded separately). After the initial biopsy, the physician uses the MRI guidance to perform percutaneous biopsies of two additional lesions.Code 19086 is reported twice, once for each additional lesion., A patient has a suspicious mass detected by mammography and confirmed on MRI.A core needle biopsy is performed on the initial lesion. During the same procedure, two more smaller, suspicious lesions are also biopsied percutaneously under MRI guidance.Code 19086 is reported twice, once for each additional lesion., A patient undergoes stereotactic breast biopsy for a single lesion.Following the initial biopsy, another lesion is identified on post-biopsy imaging which is biopsied percutaneously. 19086 is used to bill for this additional lesion.
* Pre-procedure imaging (MRI) clearly demonstrating the location of the additional breast lesion(s).* Operative report detailing the procedure for each additional lesion, including the technique used, the number of lesions biopsied, and the size and location of each specimen.* Pathology report for each biopsy specimen.* Documentation supporting medical necessity for the additional biopsies.* If performed, documentation for the placement of localization devices and imaging of the specimens.
** Always confirm payer-specific coding and reimbursement policies before submitting claims.This information is for guidance only and does not constitute medical advice.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: Not specified in provided data.Consult current Medicare fee schedule and other payer-specific RVUs.
- Global Days: Global surgical period details not provided. Check payer specific guidelines.
- Payment Status: Active
- Modifier TC rule: Not applicable. This code is not typically broken down into professional and technical components.
- Fee Schedule: Not specified.Consult historical fee schedules for relevant payers.
- Specialties:Surgical Oncology, Radiology, Breast Surgery
- Place of Service:Office, Ambulatory Surgery Center, Hospital (Inpatient or Outpatient)