Place po breast cath for rad

CPT code 19296 covers the placement of a catheter into breast tissue to deliver targeted radiation therapy directly to the tumor site after lumpectomy. This image-guided procedure allows radiation to be delivered internally rather than externally.

Showing rates for

National Average

Base Medicare rate

$3,346.89

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

3.63

PE RVU (NF)

98.95

MP RVU

0.89

Total RVU

103.47

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

NCCI bundling edits

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Billing tips

Verify place of service coding carefully—code 19296 has a $3142.46 payment differential between non-facility (POS 11/22) and facility (POS 21/22) settings
Impact: Incorrect POS coding can result in over $3000 underpayment per case or potential overpayment recoupment
Image guidance is included in 19296; do not separately bill ultrasound (76942) or mammographic guidance (77031) as these are bundled
Impact: Prevents unbundling denials and potential fraud allegations; separate imaging codes will be denied as inclusive
Document the specific type of catheter device used (single-lumen vs multi-lumen), insertion approach (percutaneous vs open), and imaging modality for medical necessity and audit defense
Impact: Comprehensive documentation supports medical necessity and reduces audit risk in this high-reimbursement procedure
Bill 19296 only once per breast regardless of number of catheters placed; multiple catheter systems are included in the single code
Impact: Prevents denials for duplicate billing; multi-catheter devices like SAVI are included in single code payment
Ensure timing is appropriate—catheter placement typically occurs within 1-10 days post-lumpectomy; document medical necessity if delayed beyond typical timeframe
Impact: Delayed placement beyond accepted clinical windows may trigger medical necessity denials
When performed with lumpectomy on same date, append modifier 59 to 19296 and review payer-specific bundling edits as some payers consider this staged
Impact: Improper modifier use can result in $3346.89 denial; some contracts require separate sessions for optimal reimbursement

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Frequently asked questions

What is the Medicare reimbursement for CPT code 19296 in 2025?

Medicare pays $3346.89 for CPT 19296 in non-facility settings and $204.43 in facility settings (hospital outpatient or ASC) under the 2025 Physician Fee Schedule. This $3142.46 differential makes accurate place of service coding critical for appropriate reimbursement.

Can CPT 19296 be billed with ultrasound or mammography guidance codes?

No, image guidance is bundled into CPT 19296 per NCCI edits. You cannot separately bill ultrasound guidance (76942) or mammographic guidance (77031) when performed for catheter placement. These imaging codes will be denied as inclusive to 19296.

How many times can you bill CPT 19296 for multiple catheters in one breast?

CPT 19296 is billed only once per breast regardless of the number of catheters placed. Multi-catheter devices like the SAVI applicator are included in the single code. Billing multiple units for one breast will result in denials for duplicate services.

What modifiers are required for CPT code 19296?

At minimum, laterality modifiers RT (right) or LT (left) should be appended to indicate which breast received the catheter. Modifier 59 may be necessary when performed with other procedures on the same date. Modifier 50 applies only in rare bilateral placement scenarios.

Can CPT 19296 be billed on the same day as a lumpectomy?

While technically possible, many payers prefer catheter placement as a staged procedure 1-10 days post-lumpectomy to allow seroma formation that optimizes cavity visualization. If performed same-day, append modifier 59 to 19296 and document medical necessity. Review individual payer policies as bundling edits vary.

What documentation is needed to support medical necessity for CPT 19296?

Required documentation includes recent lumpectomy operative report, pathology confirming early-stage breast cancer, radiation oncology consultation supporting APBI candidacy, imaging confirming adequate cavity size and skin spacing, and patient meeting established criteria (typically tumor <3cm, negative margins, limited nodal involvement per ASTRO guidelines).

What is the work RVU value for CPT 19296 in 2025?

CPT 19296 has a work RVU of 3.63, practice expense RVU of 98.95 (non-facility) or 1.8 (facility), and malpractice RVU of 0.89. The total non-facility RVU is 103.47, which when multiplied by the 2025 conversion factor of 32.3465 yields the Medicare payment of $3346.89.