Perq dev breast add strtctc

CPT 19284 covers the placement of an additional localization device in the breast using stereotactic imaging guidance (like a specialized mammography system). This is an add-on code used when more than one marker or clip is placed during the same session.

Showing rates for

National Average

Base Medicare rate

$177.91

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)

4.4

MP RVU

0.1

Total RVU

5.5

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

NCCI bundling edits

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Billing tips

Always verify the primary procedure code (19081, 19283, or similar) is billed first, as 19284 is an add-on code (indicated by '+' symbol in CPT) and will be denied if submitted alone
Impact: Prevents 100% denial; ensures receipt of $47.23-$177.91 per additional device versus $0 for standalone billing
Document each additional device placement separately with distinct imaging coordinates and anatomic location to justify multiple units of 19284
Impact: Supports billing multiple units; difference between single payment ($47.23-$177.91) versus multiple units can exceed $500 in non-facility settings
Verify place of service code matches the facility versus non-facility designation, as the rate difference is $130.68 per device (274% higher for non-facility)
Impact: Incorrect POS coding can result in $130.68 underpayment per device or overpayment requiring refund
Bill on same claim and same date of service as primary procedure code; separate claims will trigger coordination of benefits edits and denials
Impact: Prevents automatic denial and 30-60 day appeal process; ensures timely payment
Include laterality modifiers (RT/LT) even though procedure is unilateral to meet Medicare and commercial payer requirements for breast procedures
Impact: Prevents 5-10% denial rate for missing modifiers requiring resubmission
Check NCCI edits quarterly as bundling rules change; 19284 has specific edits with other breast imaging and biopsy codes
Impact: Proactive edit checking prevents 15-20% of add-on code denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 19284 in 2025?

The 2025 Medicare national average reimbursement for CPT 19284 is $177.91 in the non-facility (office) setting and $47.23 in the facility (hospital) setting. The rate difference reflects that facility overhead costs are paid separately in hospital settings.

Can CPT 19284 be billed alone or does it require another code?

CPT 19284 cannot be billed alone. It is an add-on code (indicated by the '+' symbol in CPT manual) that must be reported with a primary breast localization code such as 19081, 19283, or 19285. Billing 19284 without a primary procedure will result in automatic denial.

How many times can I bill CPT 19284 on the same date of service?

You can bill CPT 19284 multiple times on the same date corresponding to the number of additional devices placed beyond the first. If three total devices are placed, bill the primary code once and 19284 twice. Documentation must support medical necessity for each additional device with distinct anatomic locations.

What is the RVU value for CPT code 19284?

CPT 19284 has a total RVU of 5.5, composed of 1.0 work RVU, 4.4 non-facility practice expense RVU (0.36 facility PE RVU), and 0.1 malpractice RVU. These values are from the CMS 2025 Medicare Physician Fee Schedule.

What modifiers are required when billing CPT 19284?

The RT (right) or LT (left) laterality modifiers are typically required for CPT 19284 to specify which breast. Modifier 59 may be needed to indicate distinct procedural services if billing multiple units. Modifier 76 applies for repeat procedures by the same physician on the same day.

What is the difference between CPT 19284 and 19283?

CPT 19283 is the primary code for the first breast localization device placement using stereotactic guidance, while 19284 is the add-on code for each additional device placed during the same session. You would bill 19283 once for the first device and 19284 for each subsequent device.

Does CPT 19284 include the imaging guidance?

Yes, CPT 19284 includes the stereotactic imaging guidance used to place the additional localization device. The code descriptor specifically states 'percutaneous placement breast localization device with stereotactic guidance' so separate imaging codes should not be billed for the guidance component.