Perq dev breast 1st us imag

CPT code 19285 is used when a physician places a marker device or clip into breast tissue using ultrasound guidance during the first lesion biopsy. This helps surgeons locate the exact spot later if further treatment is needed.

Showing rates for

National Average

Base Medicare rate

$342.87

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

1.7

PE RVU (NF)

8.74

MP RVU

0.16

Total RVU

10.6

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

NCCI bundling edits

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Billing tips

Verify whether your setting qualifies as facility or non-facility, as this creates a $262.65 payment difference per procedure
Impact: Incorrect place of service coding can result in a 77% reduction in reimbursement ($342.87 vs $80.22)
Code 19285 is for the FIRST lesion only; use add-on code 19286 for each additional lesion in the same breast during the same session
Impact: Missing add-on codes can result in loss of $200-300 per additional lesion marked
Always append laterality modifiers (RT/LT) as most Medicare contractors and commercial payers require them for payment
Impact: Claims without laterality modifiers face automatic denial or suspension, delaying payment by 30-60 days
Do not separately bill the ultrasound guidance (76942) as it is included in 19285 per CCI edits
Impact: Unbundling 76942 will result in denial and potential audit flags; avoid $150+ in improper billing
Document the specific type of localization device used (clip type, manufacturer) and confirm ultrasound visualization of proper placement
Impact: Detailed documentation reduces denial risk by 40% and supports medical necessity in audits
When performed with biopsy codes (19083, 19084), ensure documentation clearly shows both procedures were medically necessary and separately performed
Impact: Insufficient documentation can trigger bundling denials, reducing payment by the full 19285 amount ($342.87)

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19285 in 2025?

The 2025 Medicare national average reimbursement for CPT 19285 is $342.87 in non-facility settings and $80.22 in facility settings. The significant difference reflects the overhead costs of equipment and supplies in office-based settings versus hospital outpatient departments.

Can CPT 19285 be billed with a breast biopsy code?

Yes, CPT 19285 can be billed with breast biopsy codes 19083 or 19084, but documentation must clearly support that the marker placement was a separate, medically necessary procedure. The marker is typically placed to identify the biopsy site for future surgical excision or treatment monitoring, and this clinical rationale must be documented.

What is the difference between CPT 19285 and 19286?

CPT 19285 is the primary code for placement of a localization device in the first breast lesion with ultrasound guidance. CPT 19286 is an add-on code used for each additional lesion marked in the same breast during the same session. Code 19286 cannot be billed alone and must always accompany 19285.

How many RVUs is CPT code 19285 worth?

CPT 19285 has a total RVU value of 10.6 for 2025, consisting of 1.7 work RVUs, 8.74 non-facility practice expense RVUs (0.62 facility PE RVUs), and 0.16 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A.

Do I need a modifier when billing CPT 19285 for both breasts?

Yes, when performing the procedure bilaterally, append modifier 50 (bilateral procedure) to CPT 19285. Alternatively, some payers prefer you bill 19285-RT and 19285-LT on separate lines. Always verify payer-specific bilateral billing preferences before submitting claims.

Is ultrasound guidance separately billable with CPT 19285?

No, ultrasound guidance (CPT 76942) is not separately billable with 19285 as it is bundled into the procedure code per CCI edits. The descriptor 'us imag' indicates ultrasound imaging is included. Billing both codes together will result in denial of 76942.

What documentation is required to bill CPT 19285?

Required documentation includes the clinical indication for marker placement, ultrasound visualization of the target lesion, description of the percutaneous approach, specific type of localization device used, confirmation of proper device placement via ultrasound, laterality specification, and post-procedure assessment. The operative report must clearly distinguish marker placement from any concurrent biopsy procedure.