Puncture aspir cyst brst ea

CPT code 19001 is used when a doctor uses a needle to drain fluid from a breast cyst. This is typically done to relieve discomfort or to test the fluid for abnormalities.

Showing rates for

National Average

Base Medicare rate

$25.23

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

0.42

PE RVU (NF)

0.32

MP RVU

0.04

Total RVU

0.78

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

NCCI bundling edits

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Billing tips

Bill 19001 only for each additional cyst after the first; the first cyst aspiration should be billed under CPT 19000
Impact: Incorrect sequencing results in automatic denial; using 19001 for the first cyst will deny at $25.23 per occurrence
Document the exact number of cysts aspirated, their anatomic locations (quadrant and breast), and whether fluid was obtained from each
Impact: Inadequate documentation leads to downcoding from multiple units to single unit, losing $19.73-$25.23 per undocumented cyst
When aspirating multiple cysts in the same breast, bill one unit of 19000 and additional units of 19001 with modifier 59 to prevent bundling
Impact: Proper modifier use recovers $25.23 per additional cyst versus $0 if bundled; for 3 cysts this equals $50.46 difference
Verify whether image guidance (ultrasound) was used; if so, bill 76942 or 77021 separately as these are not bundled with 19001
Impact: Adding appropriate imaging guidance codes adds $50-100 per procedure when separately reimbursable
Confirm facility vs non-facility status before billing; office-based procedures receive $25.23 while hospital outpatient receives $19.73
Impact: Billing location error results in $5.50 underpayment per procedure or potential recoupment if overclaimed
For bilateral aspirations, use modifier 50 or RT/LT based on payer preference rather than billing two separate line items without anatomic modifiers
Impact: Correct bilateral coding typically yields 150% reimbursement ($37.85) versus risk of one side denying as duplicate

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Frequently asked questions

What is the difference between CPT 19000 and 19001?

CPT 19000 is used for aspirating the first breast cyst during an encounter, while 19001 is an add-on code used for each additional cyst aspirated beyond the first. You cannot bill 19001 without also billing 19000. For example, if three cysts are aspirated, you would bill 19000 x1 and 19001 x2.

How much does Medicare pay for CPT code 19001 in 2025?

Medicare pays $25.23 for CPT 19001 when performed in a non-facility setting (physician office) and $19.73 when performed in a facility setting (hospital outpatient department) based on the 2025 national average rates. Actual payment may vary by geographic locality.

Can I bill an E/M visit with CPT 19001 on the same day?

Yes, you can bill an E/M service with 19001 on the same day if the evaluation is a significant, separately identifiable service beyond the normal pre-procedure assessment. You must append modifier 25 to the E/M code and ensure your documentation clearly distinguishes the separate evaluation from the decision to perform and preparation for the aspiration procedure.

Do I need to use ultrasound guidance for CPT 19001?

No, CPT 19001 describes aspiration performed by palpation and does not include imaging guidance. If ultrasound guidance is used, you should separately report CPT 76942 (ultrasonic guidance for needle placement) as this is not bundled with 19001. However, verify payer-specific policies as some may have different bundling rules.

What modifier do I use for bilateral breast cyst aspirations?

For bilateral breast cyst aspirations, use modifier 50 (bilateral procedure) or modifiers RT (right) and LT (left) on separate line items, depending on your payer's preference. Most Medicare contractors accept modifier 50, which typically reimburses at 150% of the unilateral rate. Always verify specific payer requirements before submitting.

How many times can I bill CPT 19001 for multiple cysts?

You can bill 19001 for each additional cyst beyond the first, with no inherent CPT limit. However, you must document the medical necessity and distinct location of each cyst aspirated. Payers may question high unit counts, so ensure documentation supports that each aspiration was a separate, medically necessary service in a different location.

What are the RVUs for CPT code 19001 in 2025?

For 2025, CPT 19001 has a Work RVU of 0.42, non-facility Practice Expense RVU of 0.32, facility Practice Expense RVU of 0.15, and Malpractice RVU of 0.04, for a total non-facility RVU of 0.78. These values multiplied by the 2025 conversion factor of 32.3465 determine the Medicare payment rates.