Perq dev breast add us imag

CPT 19286 is an add-on code for placing additional breast localization devices using ultrasound guidance during the same session. This is billed in addition to the primary procedure code when more than one marker or device is placed in the breast.

Showing rates for

National Average

Base Medicare rate

$278.18

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

0.85

PE RVU (NF)

7.67

MP RVU

0.08

Total RVU

8.6

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 (19281, 19283, or 19285) is billed on the same claim before submitting 19286
Impact: Prevents automatic denial for add-on code billed without base procedure; saves 100% of the $278.18 reimbursement
Document the exact number of additional devices placed and their specific locations in the operative report
Impact: Supports multiple units of 19286 if warranted; each additional device can generate $278.18 in non-facility settings
Verify place of service code matches the fee schedule used; facility vs non-facility rate difference is $238.07
Impact: Using POS 22 (hospital outpatient) yields $40.11 vs POS 11 (office) yields $278.18 - verify setting accuracy
Include ultrasound images with annotations showing each device placement in the medical record
Impact: Reduces audit risk and supports medical necessity; prevents recoupment averaging $278.18 per denied unit
Check NCCI edits before billing with other breast procedures; use modifier 59/XU only when clinically appropriate
Impact: Prevents bundling denials while avoiding improper unbundling that triggers audits and potential fraud allegations
Bill only for devices placed beyond the first; the initial device is included in the primary procedure code
Impact: Overbilling the first device causes denials and audit flags; correct reporting ensures clean claims

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 19286 in 2025?

The 2025 Medicare national average reimbursement for CPT 19286 is $278.18 in non-facility settings and $40.11 in facility settings. The rate varies by geographic location based on the GPCI adjustment factors.

Can CPT 19286 be billed alone or does it require a primary code?

CPT 19286 cannot be billed alone. It is an add-on code that must be reported with a primary breast device placement code such as 19281, 19283, or 19285. Both codes must appear on the same claim for the same date of service.

How many times can I bill CPT 19286 for a single patient encounter?

You can bill CPT 19286 for each additional breast localization device placed beyond the first. For example, if three devices are placed total, bill the primary code once and 19286 twice. Documentation must support the medical necessity for each additional device.

What modifiers are required when billing CPT 19286?

Use RT or LT modifiers to indicate laterality (right or left breast). Modifier 59 or XU may be needed if NCCI edits apply to prevent bundling. Do not append modifier 51 as 19286 is an add-on code exempt from multiple procedure reductions.

What is the RVU value for CPT code 19286?

CPT 19286 has a total RVU of 8.6, consisting of 0.85 work RVU, 7.67 non-facility PE RVU (0.31 facility PE RVU), and 0.08 malpractice RVU based on the 2025 Medicare Physician Fee Schedule.

What documentation is needed to support billing CPT 19286?

Required documentation includes the operative report detailing each device placement location, ultrasound images showing each device, medical necessity for multiple devices (such as multicentric lesions), the primary procedure code performed, and confirmation of ultrasound guidance for each additional device.

What are common denial reasons for CPT 19286 claims?

Common denials include: billing 19286 without a primary procedure code, insufficient documentation of medical necessity for multiple devices, missing ultrasound images, incorrect use of modifiers, and billing the first device with 19286 instead of the primary code.