2025 CPT code 19306
(Active) Effective Date: N/A Revision Date: N/A Surgery - Mastectomy Surgery Feed
Radical mastectomy, including pectoral muscles, axillary and internal mammary lymph nodes (Urban-type operation).
Modifiers 50 (bilateral procedure) and 59 (distinct procedural service) are commonly used with code 19306.Modifier 50 is appropriate for bilateral radical mastectomies. Modifier 59 may be used when the mastectomies performed on each side are different.Other modifiers may be used as clinically appropriate.
Medical necessity for a radical mastectomy (19306) is established when a patient has breast cancer that requires extensive surgical removal of the breast tissue, pectoral muscles, and regional lymph nodes to achieve local control of the disease. The decision to perform this procedure is based on the tumor's size, location, lymph node involvement, and the patient's overall health status.Payer-specific guidelines may influence the determination of medical necessity.
The clinical responsibility lies with the surgeon. This includes pre-operative evaluation, surgical procedure, and post-operative care. The surgeon is responsible for assessing the extent of the disease and selecting the appropriate surgical technique.
In simple words: The surgeon removes the entire breast, nipple, and surrounding skin, along with chest muscles and nearby lymph nodes. This is a major surgery to remove breast cancer, and it may involve additional procedures like skin grafts or breast reconstruction.
This procedure involves the complete removal of the ipsilateral breast tissue, including the nipple and areola, pectoral muscles, axillary lymph nodes, and internal mammary lymph nodes.It's considered an Urban-type radical mastectomy. The surgical approach includes an elliptical incision to remove all breast tissue, followed by electrocautery to control bleeding.Post-operative considerations may include skin grafts, flaps, or separate breast reconstruction procedures/prosthesis placement. A suction drain is typically placed, and the incision is closed without tension.
Example 1: A 55-year-old female patient diagnosed with invasive ductal carcinoma in the right breast, with lymph node involvement, undergoes a radical mastectomy (19306) to remove the cancerous tissue and regional lymph nodes. Post-operatively, she receives adjuvant chemotherapy and radiation., A 48-year-old female patient with a family history of breast cancer and a high risk of developing the disease opts for a prophylactic bilateral radical mastectomy (19306 with modifier 50). The procedure involves removing both breasts, pectoral muscles, and associated lymph nodes to minimize the risk of future cancer development., A 62-year-old female patient presents with locally advanced breast cancer requiring a radical mastectomy (19306) involving extensive resection of the breast tissue, chest muscles, and lymph nodes.Due to the extent of the surgery, she may need additional reconstructive surgery and prolonged post-operative care.
Detailed pathology report confirming the diagnosis of breast cancer.Preoperative imaging studies (mammography, ultrasound, MRI) demonstrating the extent of the tumor and lymph node involvement. Intraoperative findings documenting complete removal of the breast tissue, pectoral muscles, axillary, and internal mammary lymph nodes. Postoperative pathology report confirming clear surgical margins and the extent of lymph node dissection.Surgical notes detailing the surgical technique and any complications encountered.Physician orders for post-operative care, including pain management, wound care, and adjuvant therapies.
** Intraoperative placement of clips is not separately reported. For immediate or delayed insertion of an implant, see codes 19340 and 19342.
- Revenue Code: P1A (Major Procedure - Breast)
- RVU: This information requires access to specific payer fee schedules and may vary significantly.RVUs are not included in the provided text.
- Global Days: The global surgical period for this procedure requires further clarification based on payer-specific guidelines.The provided text does not specify a timeframe.
- Payment Status: Active
- Modifier TC rule: The TC modifier (Technical Component) is not typically applicable to 19306 as it is a comprehensive surgical procedure.The professional component is usually billed separately.
- Fee Schedule: Historical fee schedule data is not included in the provided text.This information varies by payer and year.
- Specialties:Surgical Oncology, General Surgery, Breast Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center