CPT 10035Surgery

Plmt sft tiss loclzj dev 1st

CPT code 10035 covers the placement of the first soft tissue localization device, typically a wire or marker placed into tissue (often breast) to guide surgical removal of abnormal areas found on imaging.

Showing rates for

National Average

Base Medicare rate

$339.96

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.7

PE RVU (NF)

8.65

MP RVU

0.16

Total RVU

10.51

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify site-of-service coding: non-facility rate ($339.96) applies only in office/freestanding settings; hospital outpatient department defaults to facility rate ($80.22)
Impact: $259.74 difference between settings - ensure Place of Service code matches actual location to avoid audits
Bill 10036 for each additional localization device placed during same session, not repeat 10035
Impact: Using 10035 with modifier 59 for second device commonly denied; 10036 is the correct add-on code with different reimbursement
Bundle imaging guidance with appropriate codes (76942 for ultrasound, 77002 for fluoroscopy, 77021 for MRI) - these are separately billable
Impact: Additional $50-200 per case when imaging guidance properly documented and coded separately from device placement
Document pre-procedure imaging correlation and post-placement confirmation imaging in operative report
Impact: Reduces audit risk by 40-60%; confirms medical necessity and accurate device positioning
Never bill 10035 on same day as excision without modifier 59 if performed by same provider in continuous session
Impact: Likely bundled into surgical excision payment; separate payment requires documentation of distinct, separately identifiable service
For bilateral procedures, bill 10035-LT and 10035-RT on separate lines rather than using modifier 50
Impact: Line-item billing ensures proper payment for each side; modifier 50 may cause processing errors with certain payers

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Frequently asked questions

What is the Medicare reimbursement for CPT code 10035 in 2025?

Medicare pays $339.96 for CPT 10035 in non-facility settings (office, freestanding imaging center) and $80.22 in facility settings (hospital outpatient department) based on the 2025 Physician Fee Schedule with a conversion factor of 32.3465.

Can CPT 10035 be billed with a lumpectomy on the same day?

Yes, but documentation must clearly show the localization as a distinct, separately identifiable service performed prior to the excision. Use modifier 59 and ensure separate time documentation. Many payers bundle these services when performed continuously by the same surgeon.

What is the difference between CPT 10035 and 10036?

CPT 10035 is for placement of the first soft tissue localization device, while 10036 is an add-on code for each additional device placed during the same session. Always bill 10035 first, then 10036 for second and subsequent devices; never bill multiple units of 10035.

How many RVUs is CPT code 10035 worth?

CPT 10035 has 10.51 total RVUs for 2025: 1.7 work RVU, 8.65 non-facility practice expense RVU (0.62 facility PE RVU), and 0.16 malpractice RVU. The high non-facility PE RVU accounts for the significant payment difference between settings.

Do I need a modifier when billing 10035 for breast localization?

Yes, laterality modifiers LT (left) or RT (right) are required when performing localization on the breast or any bilateral anatomic structure. Failure to include laterality modifiers commonly results in claim denials or requests for additional information.

Is imaging guidance included in CPT 10035 or billed separately?

Imaging guidance is billed separately. Use 76942 for ultrasound guidance, 77002 for fluoroscopic guidance, or 77021 for MRI guidance in addition to 10035. Both the localization device placement and imaging guidance must be documented to support separate billing.

Can CPT 10035 be performed by a radiologist or only by a surgeon?

Either specialty can perform and bill 10035. Radiologists typically perform the localization procedure shortly before surgery, while surgeons may perform it themselves. The performing physician (or their group) bills the code; both physician presence and direct performance must be documented.