Perq device breast 1st imag

CPT code 19281 covers the placement of a device into breast tissue through the skin (percutaneous) using imaging guidance for the first lesion or area. This is typically used to mark abnormal tissue for later surgical removal or to place therapeutic devices.

Showing rates for

National Average

Base Medicare rate

$231.92

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

PE RVU (NF)

MP RVU

0.17

Total RVU

7.17

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

NCCI bundling edits

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Billing tips

Verify facility vs. non-facility setting before billing - the reimbursement difference is $138.12 per procedure
Impact: Incorrect place of service coding can result in underpayment of $138.12 or overpayment triggering recoupment
Bill 19281 for the first lesion only; use add-on code 19282 for each additional lesion in the same breast during the same session
Impact: Incorrect use of 19281 for multiple lesions instead of 19282 will result in duplicate code denials and delayed payment
Document the specific imaging modality used (mammographic, ultrasound, MRI, or stereotactic) as this supports medical necessity and may affect state Medicaid rates
Impact: Missing imaging documentation is a top audit trigger and can result in full claim denial or $231.92 recoupment
Always append RT or LT modifier to indicate laterality; this is a Medicare requirement for all bilateral procedures
Impact: Claims without laterality modifiers face automatic rejections and 15-30 day payment delays
Verify that pre-authorization was obtained if placing radioactive seeds or specialized localization devices, as many payers require prior approval
Impact: Lack of pre-authorization can result in full claim denial worth $231.92 non-facility or $93.80 facility payment
When billing with same-day diagnostic imaging, ensure the imaging report explicitly states a finding requiring device placement to demonstrate medical necessity
Impact: Weak documentation linking diagnostic findings to device placement increases audit risk and potential denial of the 7.17 RVU claim

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 19281 in 2025?

The 2025 Medicare national average reimbursement for CPT 19281 is $231.92 in the non-facility setting and $93.80 in the facility setting. The difference reflects the practice expense costs associated with providing imaging equipment and supplies in a physician office versus a hospital.

What is the difference between CPT codes 19281 and 19282?

CPT 19281 is used for percutaneous device placement with imaging guidance for the first lesion in a breast, while 19282 is an add-on code used for each additional lesion in the same breast during the same session. You must bill 19281 first, then 19282 for any subsequent lesions.

Can CPT 19281 be billed with a breast biopsy on the same day?

Yes, but documentation must clearly show that the device placement and biopsy were for distinct lesions or performed at different times. You may need to append modifier 59 or XU to 19281 to indicate a separately identifiable service and prevent bundling denials.

What RVU value is assigned to CPT code 19281 for 2025?

CPT 19281 has a total RVU of 7.17 for 2025, consisting of 2.00 work RVUs, 5.00 practice expense RVUs (non-facility), 0.73 practice expense RVUs (facility), and 0.17 malpractice RVUs.

What imaging modalities are included in CPT 19281?

CPT 19281 includes imaging guidance regardless of the modality used, which can include mammography, ultrasound, MRI, or stereotactic guidance. The code descriptor does not specify a particular imaging technique, so all imaging used for device placement is bundled into the single code.

Do I need to use a modifier when billing CPT 19281 for bilateral breast procedures?

Yes, use modifier 50 for bilateral procedures or append RT (right) and LT (left) modifiers to separate line items when placing devices in both breasts during the same session. Medicare requires laterality identification for all bilateral procedures.

Is prior authorization required for CPT code 19281?

Prior authorization requirements vary by payer and device type. While Medicare typically does not require prior authorization for standard wire localization, some commercial payers and Medicaid programs may require pre-authorization, especially for radioactive seed localization or specialized devices. Always verify with the specific payer before the procedure.