Place breast cath for rad

CPT code 19297 covers the placement of a hollow catheter tube into breast tissue to deliver targeted radiation therapy directly to the tumor site. This procedure helps radiation oncologists treat breast cancer more precisely while minimizing damage to surrounding healthy tissue.

Showing rates for

National Average

Base Medicare rate

$90.57

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

1.72

PE RVU (NF)

0.66

MP RVU

0.42

Total RVU

2.8

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

NCCI bundling edits

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Billing tips

Bill imaging guidance separately with appropriate CPT codes (76942 for ultrasound, 77002 for fluoroscopy, 77021 for MRI) as these are not bundled into 19297
Impact: Adds $50-200 to total reimbursement depending on imaging modality used
Document the specific catheter type and manufacturer (MammoSite, SAVI, Contura) as some payers require brand verification for device cost pass-through
Impact: Ensures separate device reimbursement of $2,000-4,000 in addition to the $90.57 procedure fee
The facility and non-facility rates are identical at $90.57 for 2025, which is unusual; verify place of service code 22 (outpatient hospital) vs 11 (office) is correct
Impact: Incorrect POS coding triggers audits even though payment is equal
Code 19297 has a 0-day global period; radiation treatment delivery sessions billed subsequently (77761-77799) are separately reimbursable
Impact: Allows full payment for 10+ radiation treatments averaging $500-800 each over treatment course
If catheter placement fails and must be rescheduled, append modifier 53 (discontinued procedure) and document reasons; partial payment may apply
Impact: Recovers 50-75% of the $90.57 fee rather than complete write-off
Verify medical necessity documentation includes oncotype scores, tumor size, margins, and APBI eligibility criteria per ASTRO guidelines
Impact: Prevents medical necessity denials that account for 40% of 19297 claim rejections

Common denials

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Frequently asked questions

What is the Medicare reimbursement for CPT code 19297 in 2025?

The 2025 Medicare national average reimbursement for CPT 19297 is $90.57 for both facility and non-facility settings. This rate is based on 2.8 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

Can CPT 19297 be billed with a lumpectomy on the same day?

Yes, CPT 19297 can be billed with lumpectomy codes (19301, 19302) when performed during the same operative session, but modifier 59 should be appended to 19297 to indicate a distinct procedural service. However, many radiation oncologists place the catheter 1-2 weeks post-lumpectomy as a separate procedure to allow cavity formation, which eliminates bundling concerns entirely.

What imaging guidance codes can be billed with 19297?

Imaging guidance is separately billable with 19297. Common codes include 76942 (ultrasound guidance), 77002 (fluoroscopic guidance), 77021 (MRI guidance), or 77012 (CT guidance). The imaging code must be supported by documentation showing real-time guidance during catheter placement, not just pre-procedure or confirmation imaging.

Is CPT 19297 covered for all breast cancer patients?

No, coverage for 19297 is typically limited to patients meeting specific APBI eligibility criteria: age 50+, tumor size ≤3cm, negative margins, node-negative disease, and unicentric tumors. Many Medicare Administrative Contractors have Local Coverage Determinations specifying these criteria. Patients outside these parameters may face medical necessity denials.

What is the global period for CPT code 19297?

CPT 19297 has a 0-day global period, meaning there are no bundled post-operative days. All subsequent radiation treatment delivery sessions (typically CPT codes 77761-77763 for brachytherapy) and follow-up visits are separately billable. This differs from surgical lumpectomy codes which have 90-day global periods.

How do I bill for bilateral breast catheter placement?

For bilateral catheter placement, bill CPT 19297 with modifier 50 (bilateral procedure) or bill 19297 twice with RT and LT modifiers depending on payer preference. Medicare typically reimburses bilateral procedures at 150% of the unilateral rate, which would be approximately $135.86 for both sides combined.

What are the work RVUs for CPT 19297?

CPT 19297 has 1.72 work RVUs, 0.66 practice expense RVUs (same for both facility and non-facility), and 0.42 malpractice RVUs, totaling 2.8 RVUs. The work RVU component reflects physician time, intensity, and technical skill required for image-guided catheter placement in breast tissue.