Perq dev breast add mr guide

CPT 19288 covers the additional work when a doctor places a device (like a marker clip or localization wire) in the breast using MRI guidance. This is an add-on code used when additional breast lesions beyond the first one need markers placed during the same MRI session.

Showing rates for

National Average

Base Medicare rate

$452.53

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

1.28

PE RVU (NF)

12.59

MP RVU

0.12

Total RVU

13.99

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 (19287) is billed first; 19288 will auto-deny if billed without the base code on the same claim
Impact: Prevents 100% denial of the $452.53 reimbursement; primary code denial also invalidates add-on code
Document each lesion's exact location with clock position, distance from nipple, and quadrant for each additional device placement to support multiple units
Impact: Justifies billing multiple units of 19288; each additional unit adds $452.53 in non-facility settings
Bill in non-facility setting when performed in freestanding imaging center to capture the $392.04 differential versus facility rate
Impact: Non-facility rate is $452.53 vs facility rate of $60.49, representing 648% higher reimbursement
Include separate imaging documentation (MRI sequences, coordinates) for each device placement to establish distinct procedural services
Impact: Reduces audit risk and supports medical necessity for multiple units; prevents recoupment demands averaging $450+ per unit
Verify patient has not exceeded reasonable number of device placements (typically 3-4 maximum) as higher volumes trigger automatic payer review
Impact: Prevents payment delays and audit flags; each denied unit represents $452.53 in lost revenue
Code to the highest specificity by appending laterality modifiers (RT/LT) even when not required by payer to future-proof against policy changes
Impact: Prevents future claim adjustments and establishes clean billing patterns for audits

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Frequently asked questions

What is CPT code 19288 used for?

CPT 19288 is an add-on code used to report each additional MRI-guided breast device placement beyond the first. It covers placing markers, clips, or localization wires in additional breast lesions during the same MRI session when a patient has multiple suspicious areas requiring identification for surgical planning or biopsy.

How much does Medicare pay for CPT 19288 in 2025?

Medicare pays $452.53 for CPT 19288 in non-facility settings and $60.49 in facility settings for 2025. The significant difference reflects that non-facility rates include equipment and overhead costs, while facility rates only cover professional services when performed in a hospital or ASC.

Can CPT 19288 be billed alone?

No, CPT 19288 cannot be billed alone. It is an add-on code that must be reported with the primary MRI-guided breast device placement code 19287. Billing 19288 without the primary code will result in automatic denial by all payers.

How many units of 19288 can be billed per patient?

The number of units of 19288 that can be billed depends on the number of additional distinct lesions requiring device placement beyond the first (covered by 19287). While there is no absolute limit, most cases involve 1-3 additional devices. Billing more than 3-4 units typically triggers payer review requiring detailed documentation of medical necessity for multiple separate lesions.

What modifiers are required for CPT 19288?

Laterality modifiers RT (right) or LT (left) are recommended for anatomical clarity. Modifier 59 or XU may be required when billing multiple units to demonstrate distinct procedural services for separate lesions. The specific modifier requirements vary by payer, but documenting distinct anatomical locations is essential for payment of multiple units.

What is the RVU value for CPT 19288?

CPT 19288 has a total RVU of 13.99 for 2025, comprising 1.28 work RVU, 12.59 non-facility practice expense RVU (0.47 facility), and 0.12 malpractice RVU. The high practice expense RVU reflects the costly MRI equipment and supplies required for image-guided breast procedures.

What documentation is needed to bill 19288?

Documentation must include the pre-procedure MRI identifying each target lesion with specific coordinates, real-time MRI guidance notes for each device placement, confirmation imaging showing final positions, and clear medical necessity for each additional localization. Each lesion should be documented with clock position, distance from nipple, depth, and quadrant to establish distinct anatomical locations supporting multiple units.