Cryosurg ablate fa each

CPT code 19105 covers cryosurgical ablation of a breast fibroadenoma—a procedure that uses extreme cold to freeze and destroy benign breast tumors without traditional surgery. This minimally invasive technique is performed using imaging guidance to precisely target the abnormal tissue.

Showing rates for

National Average

Base Medicare rate

$2,115.78

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

3.69

PE RVU (NF)

60.78

MP RVU

0.94

Total RVU

65.41

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

NCCI bundling edits

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Billing tips

Verify place of service code matches actual location (POS 22 for outpatient hospital, POS 11 for office, POS 24 for ASC) as this determines facility vs non-facility rate
Impact: $1911.67 difference between non-facility ($2115.78) and facility ($204.11) reimbursement—incorrect POS coding costs practices over 90% of potential revenue
Ensure prior biopsy documentation proving benign pathology is in medical record before procedure; cryoablation of unconfirmed lesions will be denied
Impact: Prevents 100% claim denial and medical necessity denials; prior biopsy typically within 3-6 months of cryoablation is standard of care
Bill imaging guidance separately (76942 for ultrasound guidance) as it is not bundled with 19105 per NCCI edits
Impact: Additional $150-250 revenue per procedure depending on payer; failure to bill separately leaves money on the table
Document patient counseling on surgical excision alternatives and reasons for choosing cryoablation over traditional surgery in procedure note
Impact: Strengthens medical necessity documentation and reduces likelihood of denial or audit recoupment on claims averaging $2115.78
For multiple lesions in same breast, code 19105 for first lesion only; subsequent lesions should be reported with an appropriate add-on code if available or may not be separately reimbursable
Impact: Prevents unbundling denials and downcoding; check specific payer policy as some allow multiple units with modifier 59 while others do not
Submit operative report and pathology report from prior biopsy with initial claim submission for commercial payers to reduce likelihood of documentation requests

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 19105 in 2025?

The 2025 Medicare national average reimbursement for CPT 19105 is $2115.78 in the non-facility (office) setting and $204.11 in the facility (hospital/ASC) setting. The dramatic difference reflects that the non-facility rate includes practice expense for equipment, while the facility rate assumes the hospital owns the equipment and provides the space.

Can CPT 19105 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended when cryoablation is performed on fibroadenomas in both breasts during the same operative session. This typically reimburses at 150% of the unilateral rate. Always verify bilateral procedure policies with specific payers before the procedure.

Is imaging guidance included in CPT 19105 or billed separately?

Imaging guidance is billed separately. CPT 19105 does not include imaging guidance in its code description. Most commonly, ultrasound guidance (CPT 76942) is used and should be reported separately as it is not bundled per NCCI edits, adding $150-250 to the total procedural reimbursement.

What documentation is required to prove medical necessity for CPT 19105?

Medical necessity requires: (1) pathology report from prior core needle biopsy confirming benign diagnosis, (2) imaging studies showing lesion characteristics, (3) documentation of patient counseling on alternatives including surgical excision and observation, (4) clinical rationale for choosing cryoablation over other options, and (5) notation that lesion meets size and location criteria suitable for cryoablation.

How many RVUs is CPT code 19105 worth in 2025?

CPT 19105 has a total RVU value of 65.41 in 2025, comprised of 3.69 work RVUs, 60.78 non-facility practice expense RVUs (1.68 facility PE RVUs), and 0.94 malpractice RVUs. The high PE RVU reflects the expensive cryoablation equipment required for the procedure.

What are common denial reasons for CPT 19105 claims?

The most common denials include: lack of prior biopsy documentation proving benign pathology, investigational/experimental treatment determinations from payers without established coverage policies, incorrect place of service coding, and bundling denials when billed with other breast procedures on the same date. Medical necessity denials occur when documentation doesn't support choosing cryoablation over surgical excision.

Can multiple fibroadenomas be treated and billed during the same session?

CPT 19105 typically covers one lesion per code. Treatment of multiple fibroadenomas in the same breast during one session has variable payer policies—some allow multiple units with modifier 59 for distinct lesions, while others consider it inclusive. Always verify specific payer policy before treating multiple lesions, as billing practices vary significantly and inappropriate coding can trigger denials.