2025 CPT code 19499

Unlisted procedure, breast.

Use this code only when a more specific CPT code is not available for the breast procedure performed. Always submit supporting documentation with the claim, including a detailed operative report describing the procedure, its purpose, and the techniques used.This documentation helps insurers understand the procedure performed and determine appropriate reimbursement. Do not select a CPT code that approximates the service provided; use the appropriate unlisted procedure code.

Modifiers may be applicable to this code depending on the specific circumstances of the procedure.Commonly used modifiers include 50 (bilateral procedure), 62 (two surgeons), and others as appropriate.

Medical necessity must be established for the procedure performed.Documentation should clearly indicate the clinical rationale for the procedure and justify why it was necessary for the patient's condition.

In simple words: This code is used when a doctor performs a procedure on the breast that doesn't have its own specific code.Extra paperwork is required to explain exactly what was done.

This code is used to report a breast procedure for which there is no specific CPT code.It is essential to submit supporting documentation with the claim to clarify the exact nature of the procedure performed.

Example 1: A surgeon performs a novel breast reconstruction technique using tissue engineering that does not have a dedicated CPT code.Code 19499 would be reported along with detailed documentation of the procedure., A patient undergoes a complex breast biopsy involving multiple tissue planes and requiring specialized imaging guidance. If no existing code accurately reflects the complexity of the biopsy, 19499 can be used., A physician performs an innovative procedure to remove a breast implant entangled with scar tissue, a scenario not covered by existing codes.Code 19499 would be appropriate in this situation, accompanied by documentation.

Detailed operative report describing the procedure performed, the reason for the procedure, the techniques used, and the time, effort, and equipment required. Documentation should also explain why a specific code is not available and provide comparable codes for reference.

** When reporting 19499, it is best to contact the payer in advance for pre-authorization to ensure coverage. Provide them with detailed documentation before the scheduled procedure to avoid claim denials.

  • Specialties:Plastic Surgery, General Surgery, Surgical Oncology
  • Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient
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