Puncture aspir cyst breast

CPT code 19000 covers the procedure where a doctor inserts a needle into a breast cyst to drain fluid, similar to using a syringe to remove liquid from a swollen area. This is a diagnostic and therapeutic procedure that can relieve discomfort and help determine if the lump is benign.

Showing rates for

National Average

Base Medicare rate

$94.13

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

0.84

PE RVU (NF)

1.95

MP RVU

0.12

Total RVU

2.91

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

NCCI bundling edits

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Billing tips

Always verify place of service code—POS 11 (office) yields $94.13 while POS 22 (hospital outpatient) yields only $41.08
Impact: Correct POS coding can mean $53.05 difference (129% higher reimbursement) per procedure
Do not bill 19000 with imaging guidance codes (76942, 77021); use 19081 or 19082 instead when ultrasound or stereotactic guidance is used
Impact: Prevents 100% denial due to NCCI edits; proper code selection increases payment to $150-$300 range
Bill each additional cyst separately with appropriate units or 19001 if available by payer; some Medicare MACs require separate line items
Impact: Ensures payment for multiple aspirations—potentially $94.13 per additional cyst versus zero if not reported
Document whether fluid was sent for cytology (88172-88173) as this is separately billable and supports medical necessity
Impact: Additional $30-$80 in reimbursement when pathology services are documented and billed
Link appropriate ICD-10 codes (N60.01-N60.09 for solitary cyst, R92.0 for mammographic findings) to support medical necessity
Impact: Reduces denial rate by 40-60%; unsupported diagnosis codes trigger automatic medical review
For Medicare patients, verify the procedure meets LCD/NCD requirements and obtain ABN if frequency limits may apply
Impact: Protects practice from $94.13 write-off when Medicare denies as not reasonable and necessary

Common denials

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Frequently asked questions

What is the Medicare reimbursement for CPT code 19000 in 2025?

The 2025 Medicare national average reimbursement for CPT 19000 is $94.13 when performed in a non-facility setting (physician office) and $41.08 when performed in a facility setting (hospital outpatient department). These rates are based on the total RVU of 2.91 multiplied by the 2025 conversion factor of 32.3465.

Can CPT 19000 be billed with an office visit on the same day?

Yes, CPT 19000 can be billed with an E/M service on the same day if modifier 25 is appended to the E/M code and documentation clearly demonstrates a significant, separately identifiable evaluation and management service beyond the usual pre- and post-procedure work. The E/M must address problems or conditions separate from the decision to perform aspiration or involve comprehensive evaluation warranting separate payment.

What is the difference between CPT 19000 and 19081?

CPT 19000 is for needle aspiration of a breast cyst without imaging guidance (palpable mass felt by hand), while CPT 19081 is for breast biopsy with placement of localization device using imaging guidance (ultrasound, stereotactic, or MRI). Code 19081 is used when imaging is required to locate and target the lesion, includes the guidance in the code, and reimburses at a significantly higher rate.

How do you bill for aspiration of multiple breast cysts?

For aspiration of multiple breast cysts, check payer-specific guidelines. Some payers accept multiple units of 19000, while others may have deleted add-on code 19001 for each additional cyst. Document each cyst separately with distinct locations (clock position, quadrant) and consider modifier 59 if needed to indicate distinct procedural services. Most Medicare contractors allow billing per cyst aspirated with appropriate documentation.

What diagnosis codes support medical necessity for CPT 19000?

Common supporting ICD-10 codes include N60.01-N60.09 (solitary cyst of breast, specify laterality), N63.10-N63.20 (unspecified lump in breast), R92.0 (mammographic microcalcification), and R92.8 (other abnormal findings on breast imaging). Avoid screening codes (Z12.31) as primary diagnosis, and ensure the diagnosis reflects a symptomatic or diagnostic indication rather than routine screening.

Is CPT 19000 bundled with breast ultrasound codes?

Yes, CPT 19000 has NCCI edits that bundle it with breast ultrasound codes (76641, 76642) and ultrasound-guided biopsy codes. If ultrasound guidance is used during the aspiration, you should report 19081 instead of 19000. If ultrasound is performed for diagnostic purposes separate from the aspiration and aspiration is done by palpation alone, modifier 59 may be appropriate with clear documentation supporting distinct services.

What are the RVU values for CPT code 19000 in 2025?

The 2025 RVU values for CPT 19000 are: Work RVU 0.84, Practice Expense RVU 1.95 (non-facility) or 0.31 (facility), and Malpractice RVU 0.12, for a total non-facility RVU of 2.91. These values multiplied by the 2025 conversion factor of 32.3465 determine the Medicare payment rates of $94.13 (non-facility) and $41.08 (facility).