Perq dev breast 1st mr guide

CPT code 19287 covers the placement of a biopsy localization device in the breast using MRI guidance for the first lesion. This is performed before surgical removal to help the surgeon find the exact location of abnormal tissue detected on MRI.

Showing rates for

National Average

Base Medicare rate

$590.32

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

2.55

PE RVU (NF)

15.48

MP RVU

0.22

Total RVU

18.25

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

NCCI bundling edits

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Billing tips

Always verify whether you're billing in facility or non-facility setting before claim submission
Impact: Incorrect place of service code can result in $470.64 underpayment (difference between non-facility $590.32 and facility $119.68)
Bill additional lesions with add-on code 19288 when multiple lesions require localization during same session
Impact: Failing to bill 19288 for 2nd+ lesions leaves significant revenue on table; each additional lesion generates separate reimbursement
Document medical necessity clearly explaining why MRI guidance was required instead of less expensive mammographic or ultrasound guidance
Impact: MRI-only visible lesions must be clearly documented to justify the higher-paying MRI guidance versus stereotactic or ultrasound approaches
Ensure RT or LT modifier is appended to every claim to meet anatomic site requirements
Impact: Missing laterality modifier is among top 3 denial reasons; can delay payment by 30-60 days requiring corrected claim submission
Coordinate with surgical team to confirm localization timing and avoid same-day surgical excision billing conflicts
Impact: Poor coordination can trigger bundling edits if excision billed same day without appropriate modifiers, potentially losing $590.32
Separately report and document the diagnostic MRI if performed on different date; do not bundle with localization procedure
Impact: Diagnostic breast MRI (77048/77049) performed prior to localization represents additional $300-400 in legitimate reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 19287 in 2025?

The 2025 Medicare national average reimbursement for CPT 19287 is $590.32 in non-facility settings and $119.68 in facility settings. The significant difference reflects facility overhead costs being included in the non-facility rate.

What RVU value does CPT 19287 have for 2025?

CPT 19287 has a total RVU of 18.25 for 2025, consisting of 2.55 work RVU, 15.48 non-facility PE RVU (0.93 facility PE RVU), and 0.22 malpractice RVU. The high PE RVU reflects the expensive MRI equipment required.

Can CPT 19287 be billed bilaterally with modifier 50?

Yes, modifier 50 can be used when MRI-guided device placement is performed in both breasts during the same session. However, documentation must support medical necessity for bilateral localization, and many payers require RT/LT modifiers with two line items rather than modifier 50.

What is the difference between CPT 19287 and 19288?

CPT 19287 is for the first lesion localized with MRI guidance, while 19288 is an add-on code for each additional lesion localized during the same session. Code 19288 cannot be billed alone and must always accompany 19287.

Do I need prior authorization to bill CPT code 19287?

Prior authorization requirements vary by payer. Medicare does not require prior auth for 19287, but many commercial payers do require pre-authorization for MRI-guided procedures due to higher cost compared to ultrasound or mammographic guidance. Always verify with specific payer.

Can CPT 19287 be billed on the same day as a breast MRI?

Yes, diagnostic breast MRI (77048/77049) performed on the same day as localization can be separately billed if medical necessity supports both services. However, the diagnostic MRI should ideally be performed on a prior date with localization scheduled after lesion identification and treatment planning.

What modifiers are required when billing CPT 19287?

At minimum, laterality modifiers RT (right) or LT (left) are required by most payers. Additional modifiers may include 26 (professional component), TC (technical component), 59 (distinct service), or 76 (repeat procedure) depending on the specific circumstances of the service provided.