Partial mastectomy

CPT 19301 covers partial mastectomy, a surgical procedure to remove part of the breast tissue, typically performed to treat breast cancer or remove abnormal tissue while preserving as much of the breast as possible.

Showing rates for

National Average

Base Medicare rate

$647.25

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

10.13

PE RVU (NF)

7.37

MP RVU

2.51

Total RVU

20.01

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always append RT or LT modifier to indicate laterality; claims without laterality modifiers face automatic denial by Medicare and most commercial payers
Impact: Prevents 100% payment denial and 2-4 week claims processing delay
Document margin status and specimen weight in operative report; re-excision for positive margins (within 90-day global) requires modifier 58 with clear documentation that margins were positive on pathology
Impact: Enables separate payment of $647.25 for re-excision that would otherwise be denied as included in global period
Do not bill 19301 with wire localization codes (19281-19282) as separate procedures; localization is bundled per NCCI edits and will be denied
Impact: Avoid claim denials and recoupment attempts averaging $150-200 for unbundled localization procedures
For bilateral procedures (modifier 50), ensure medical necessity is clearly documented for both breasts; many payers require separate diagnoses or synchronous bilateral cancer documentation
Impact: Secures full bilateral payment of $970.88 versus risk of unilateral-only payment at $647.25
When performed with sentinel lymph node biopsy (38525), ensure both procedures are medically necessary and documented; bill 38525 first as primary procedure due to higher RVU value
Impact: Maximizes reimbursement by avoiding multiple procedure reduction on higher-valued code
For Medicare patients, verify LCD requirements for breast cancer surgery in your jurisdiction; some MACs require specific pathology documentation prior to authorization
Prevents denials for medical necessity and reduces prior authorization delays averaging 7-14 days

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 19301?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 19301 in 2025?

The 2025 Medicare national average reimbursement for CPT 19301 is $647.25 for both facility and non-facility settings, based on 20.01 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 19301 be billed bilaterally with modifier 50?

Yes, CPT 19301 can be billed with modifier 50 for bilateral partial mastectomy performed during the same operative session, which typically reimburses at 150% of the unilateral rate. Both RT and LT modifiers should not be used when billing with modifier 50; use modifier 50 alone for bilateral procedures.

What modifiers are required when billing CPT 19301?

Laterality modifiers RT (right) or LT (left) are mandatory for unilateral procedures. Additional modifiers may include 50 (bilateral), 58 (staged re-excision), 78 (unplanned return to OR), 22 (increased complexity), or 59 (distinct procedural service) depending on specific circumstances.

Can CPT 19301 be billed with wire localization codes?

No, CPT 19301 cannot be separately billed with wire localization codes 19281-19282 as these are bundled per NCCI edits. The localization procedure is considered integral to the partial mastectomy and attempting to bill separately will result in denial.

How do I bill a re-excision for positive margins after CPT 19301?

Re-excision for positive margins within the 90-day global period should be billed using CPT 19301 again with modifier 58 (staged procedure). Documentation must include the pathology report showing positive margins from the initial procedure and operative report for the re-excision clearly stating the indication.

What is the difference between CPT 19301 and 19302?

CPT 19301 is for partial mastectomy alone, while CPT 19302 includes partial mastectomy with axillary lymphadenectomy (removal of axillary lymph nodes). Code selection depends on whether axillary node dissection is performed in addition to the breast tissue removal.

Can CPT 19301 be billed with sentinel lymph node biopsy codes?

Yes, CPT 19301 can be appropriately billed with sentinel lymph node biopsy codes (38525 for biopsy, 38900 for injection) when both procedures are medically necessary and documented. These are separate procedures that are not bundled, and both should be reported with appropriate modifiers and sequenced with the higher RVU code listed first.