P-mastectomy w/ln removal
CPT code 19302 covers a partial mastectomy with lymph node removal, a surgical procedure where the surgeon removes part of the breast tissue along with nearby lymph nodes, typically to treat or diagnose breast cancer.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always append RT or LT modifier to specify laterality; failure to include anatomical modifier results in automatic claim denial
Impact: Prevents 100% claim denial and 30-45 day payment delay
Document number and levels of lymph nodes removed separately; if sentinel node only, consider CPT 38525 instead of 19302
Impact: Incorrect code selection results in $300-500 underpayment when axillary dissection not performed
Do not unbundle needle localization (19281-19288) when performed same day; these are separately reportable with modifier 59
Impact: Recovers additional $150-300 when wire localization documented separately
For positive margins requiring re-excision within global period, use modifier 58 with documentation of planned staged approach
Impact: Ensures full $889.21 reimbursement instead of $0 during 90-day global period
Link appropriate breast cancer diagnosis codes (C50.x series) with specific quadrant and laterality matching operative report
Impact: Prevents medical necessity denials and supports higher-severity DRG assignment in facility billing
Submit operative report showing both partial mastectomy AND lymph node dissection components; single procedure documentation causes downcoding
Impact: Prevents downcoding to 19301 (partial mastectomy alone at $636.52), protecting $252.69 per case
Common denials
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