CPT 10036Surgery

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CPT code 10036 covers the placement of a small marker or wire into soft tissue to help surgeons locate abnormal areas (like suspicious lumps) during a procedure. This is commonly done before breast biopsies or tumor removals to guide the surgeon to the exact spot.

Showing rates for

National Average

Base Medicare rate

$276.24

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

0.85

PE RVU (NF)

7.59

MP RVU

0.1

Total RVU

8.54

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

NCCI bundling edits

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Billing tips

Bill per device placed, not per lesion or per session—if three wires are placed, report 10036 three times with appropriate modifiers
Impact: Proper unit billing can increase reimbursement from $276.24 to $828.72 for three-device placement in non-facility setting
Verify place of service coding carefully—POS 22 (hospital outpatient) yields $40.76 while POS 11 (office) yields $276.24, a difference of $235.48 per device
Impact: Incorrect POS coding can result in $235.48 underpayment or overpayment per device, triggering audits or leaving money on table
Do not separately bill imaging guidance codes (76942, 77002, 77021) when billing 10036—guidance is included in the procedure reimbursement
Impact: Prevents denials for unbundling and avoids compliance risk; attempting to bill separately may trigger $100-400 in inappropriate charges
Document the specific type of localization device used (wire, seed, reflector) and the imaging modality (ultrasound, stereotactic, MRI) to support medical necessity
Impact: Reduces denial rate by approximately 15-25% and expedites payment by providing clear documentation of technique
For multiple lesions in the same breast quadrant, ensure documentation clearly differentiates each target to support multiple units
Impact: Prevents payer downcoding from 3 units to 1 unit, protecting up to $552.48 per case in non-facility settings
Submit claims within 48 hours of service when possible, as localization procedures are typically followed by same-day or next-day surgery that may create claim sequencing issues
Improves clean claim rate by 10-15% and reduces coordination of benefits delays that can extend payment cycles by 30-45 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 10036 in 2025?

The 2025 Medicare national average reimbursement for CPT 10036 is $276.24 in non-facility settings and $40.76 in facility settings. The significant difference reflects that non-facility rates include equipment and overhead costs, while facility rates assume the hospital provides these resources.

Can CPT 10036 be billed multiple times on the same date of service?

Yes, CPT 10036 should be billed once for each localization device placed. If three wires are inserted to mark multiple lesions, report 10036 with quantity of 3, using appropriate modifiers (59, XS, or RT/LT) to indicate distinct procedural services and prevent bundling denials.

What imaging guidance codes can be billed with CPT 10036?

No separate imaging guidance codes should be billed with CPT 10036. The code is comprehensive and includes all imaging guidance (ultrasound, mammographic, or MRI). Billing 76942, 77002, or 77021 separately will result in bundling denials under NCCI edits.

Is CPT 10036 used only for breast procedures?

While CPT 10036 is most commonly used for breast lesion localization, it can be used for soft tissue localization in any anatomic location where a non-palpable lesion requires marking prior to surgical excision, including thyroid, lymph nodes, or other soft tissue masses.

What modifiers are required when billing CPT 10036 bilaterally?

For bilateral breast localization, use RT (right) and LT (left) modifiers on separate line items to indicate laterality. Some payers accept modifier 50 (bilateral procedure), but RT/LT modifiers provide clearer anatomic specificity and are preferred by most payers to avoid processing delays.

How many RVUs does CPT 10036 have in 2025?

CPT 10036 has 8.54 total RVUs in 2025, comprised of 0.85 work RVUs, 7.59 non-facility practice expense RVUs (0.31 facility PE RVUs), and 0.10 malpractice RVUs. The high PE RVU reflects the imaging equipment and supplies required for the procedure.

Can a radiologist and surgeon both bill for the same localization procedure?

No, only one provider can bill CPT 10036 for each device placement. Typically, the radiologist or imaging physician who performs the image-guided placement bills 10036, while the surgeon bills only the excision code (such as 19120 or 19301). Duplicate billing by both providers will result in denial.