Njx px only mam ducto/glcto

CPT 19030 covers the injection of contrast dye into breast milk ducts to visualize them on imaging (ductography or galactography). This diagnostic procedure helps identify abnormalities in the ductal system, such as papillomas or other lesions causing nipple discharge.

Showing rates for

National Average

Base Medicare rate

$156.88

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

1.53

PE RVU (NF)

3.17

MP RVU

0.15

Total RVU

4.85

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

NCCI bundling edits

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Billing tips

Bill in non-facility setting when performed in office or private imaging center to capture full $156.88 reimbursement
Impact: 116% higher reimbursement ($84.42 difference) compared to facility setting; ensure place of service code matches actual location
Separately bill the imaging component (76086 or 76087 for ductography) as 19030 covers injection only, not radiological supervision or interpretation
Impact: Captures additional $50-100 in reimbursement for complete ductography service; common underbilling error costs approximately 40% of total procedure revenue
Document the specific duct cannulated, contrast type and volume injected, and medical necessity for discharge evaluation
Impact: Reduces denial rate by approximately 30%; inadequate documentation is leading cause of medical necessity denials for this code
Use laterality modifiers (RT/LT) on every claim to prevent processing delays and unnecessary documentation requests
Impact: Prevents 15-20% of claims from pended status requiring manual review; accelerates payment by 10-14 days on average
Verify that nipple discharge is documented as pathologic (spontaneous, unilateral, single duct) rather than physiologic to support medical necessity
Impact: Physiologic discharge documentation leads to 60-70% denial rate; proper characterization ensures coverage
Check payer-specific policies on global surgical package, as some payers may bundle E/M services on same day without modifier 25
Impact: Properly appending modifier 25 to significant, separately identifiable E/M can capture additional $75-150 when medically appropriate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19030 in 2025?

The 2025 Medicare national average reimbursement for CPT 19030 is $156.88 in non-facility settings and $72.46 in facility settings. The non-facility rate applies when performed in a physician's office or private imaging center, while the facility rate applies in hospital outpatient departments or ambulatory surgery centers.

Does CPT 19030 include the mammography or imaging portion of ductography?

No, CPT 19030 covers only the injection procedure itself. The imaging component must be billed separately using CPT 76086 (bilateral) or 76087 (unilateral) for the mammographic ductography images, or the appropriate code for radiological supervision and interpretation.

What modifiers are required when billing CPT 19030?

Laterality modifiers RT (right) or LT (left) are required for unilateral procedures. Modifier 50 should be used for bilateral procedures. Modifier 59 may be necessary if performed with other procedures to indicate a distinct service. Always verify payer-specific modifier requirements.

Can CPT 19030 be billed with an E/M service on the same day?

Yes, but only if the E/M service is significant and separately identifiable from the pre-procedure evaluation. Append modifier 25 to the E/M code and document the distinct nature of the evaluation. The E/M must address issues beyond the decision for and explanation of the injection procedure itself.

What documentation is needed to support medical necessity for CPT 19030?

Documentation must include characteristics of pathologic nipple discharge (spontaneous, unilateral, single duct origin, bloody/serous/clear), duration of symptoms, clinical breast exam findings, and explanation of why ductography is appropriate for diagnosis. Physiologic or bilateral multi-duct discharge typically does not meet medical necessity criteria.

How many RVUs is CPT code 19030 worth in 2025?

CPT 19030 has a total of 4.85 RVUs in 2025, consisting of 1.53 work RVUs, 3.17 non-facility practice expense RVUs (0.56 facility PE RVUs), and 0.15 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What are common reasons for denial of CPT 19030 claims?

Common denials include lack of medical necessity (inadequate documentation of pathologic discharge), incorrect bundling with imaging codes, missing laterality modifiers, characterization of discharge as physiologic rather than pathologic, and insufficient clinical documentation supporting the diagnostic need for ductography versus other imaging modalities.