Mast radical

CPT code 19305 covers a radical mastectomy, which is the complete surgical removal of the breast along with the underlying chest muscle and lymph nodes in the armpit area. This extensive procedure is typically performed for advanced breast cancer cases.

Showing rates for

National Average

Base Medicare rate

$1,122.10

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

17.46

PE RVU (NF)

12.85

MP RVU

4.38

Total RVU

34.69

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

NCCI bundling edits

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Billing tips

Document chest wall muscle involvement and medical necessity for radical versus modified radical approach
Impact: Critical for coverage determination; failure to document muscle involvement may trigger downcoding to 19307 (modified radical mastectomy) reducing payment by approximately $200-300
Always append laterality modifiers (RT/LT) on initial claim submission
Impact: Prevents automatic denials requiring resubmission; laterality modifiers are mandatory for Medicare and most commercial payers, avoiding 15-30 day payment delays
Bill separately for immediate reconstruction using appropriate CPT codes (19357-19369) with modifier 58 if staged
Impact: Reconstruction procedures are separately reimbursable; typical immediate reconstruction adds $800-2500 depending on technique when properly documented
Code sentinel lymph node biopsy (38900) or axillary dissection separately only if not included in radical mastectomy documentation
Impact: Radical mastectomy descriptor includes axillary node dissection; billing 38740-38745 separately risks bundling denial and potential audit flags
Submit medical records demonstrating tumor size, location, muscle involvement, and staging with initial claim for high-dollar cases
Impact: Proactive documentation submission reduces review delays and appeals; speeds payment by 20-45 days for claims over $1000
Use modifier 22 conservatively with percentage-based fee increase request and comparison to standard procedure
Impact: Well-documented modifier 22 claims can increase reimbursement by $225-560 (20-50% above base rate) but poorly supported claims face automatic denial

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Frequently asked questions

What is the difference between CPT 19305 and 19307?

CPT 19305 (radical mastectomy) includes removal of the breast, pectoralis major and minor muscles, and axillary lymph nodes, while 19307 (modified radical mastectomy) preserves the pectoral muscles and only removes breast tissue and axillary nodes. The radical procedure is rarely performed today and reimburses at $1122.10 compared to approximately $900-950 for the modified approach.

How much does Medicare pay for CPT code 19305 in 2025?

Medicare pays $1122.10 for CPT 19305 in 2025 based on the national average rate. Both facility and non-facility rates are identical at $1122.10, with a total RVU value of 34.69 (17.46 work RVUs, 12.85 practice expense RVUs, and 4.38 malpractice RVUs).

Is radical mastectomy still performed or is it an outdated procedure?

Radical mastectomy (CPT 19305) is rarely performed in modern practice, having been largely replaced by modified radical mastectomy and breast-conserving surgery. It may still be indicated in select cases of locally advanced breast cancer with direct pectoralis muscle invasion or in specific recurrent disease scenarios where muscle removal is oncologically necessary.

Can I bill axillary lymph node dissection separately with CPT 19305?

No, axillary lymph node dissection is included in the CPT 19305 descriptor for radical mastectomy and should not be billed separately using codes 38740-38745. Billing these codes together will result in bundling denials as the lymph node dissection is considered an integral component of the radical mastectomy procedure.

What modifiers are required when billing CPT 19305?

Laterality modifiers RT (right) or LT (left) are required for CPT 19305 to specify which breast underwent radical mastectomy. Modifier 50 is used for bilateral procedures performed during the same session. Modifier 22 may be appropriate for unusual complexity, and modifier 58 for staged procedures during the global period.

Does CPT 19305 include breast reconstruction?

No, CPT 19305 covers only the radical mastectomy procedure itself and does not include breast reconstruction. Immediate or delayed reconstruction should be coded separately using appropriate reconstruction codes (19357-19369) and may require modifier 58 if performed during the global period as a staged procedure.

What documentation is needed to prevent denial of CPT 19305?

Documentation must include a detailed operative report explicitly stating removal of pectoralis major and minor muscles, complete axillary dissection, medical necessity explaining why radical versus modified approach was required, tumor involvement of chest wall or muscle, laterality, and supporting pathology reports confirming muscle tissue in the surgical specimen.